Aortic reservoir characteristics and brain structure in people with type 2 diabetes mellitus; a cross sectional study

Abstract

BackgroundCentral hemodynamics help to maintain appropriate cerebral and other end-organ perfusion, and may be altered with ageing and type 2 diabetes mellitus (T2DM). We aimed to determine the associations between central hemodynamics and brain structure at rest and during exercise in people with and without T2DM.MethodsIn a sample of people with T2DM and healthy controls, resting and exercise measures of aortic reservoir characteristics (including excess pressure integral [Pexcess]) and other central hemodynamics (including augmentation index [AIx] and aortic pulse wave velocity [aPWV]) were recorded. Brain volumes (including gray matter volume [GMV] and white matter lesions [WML]) were derived from magnetic resonance imaging (MRI) scans. Multivariable linear regression was used to study the associations of hemodynamic variables with brain structure in the two groups adjusting for age, sex, daytime systolic BP (SBP) and heart rate.ResultsThere were 37 T2DM (63 ± 9 years; 47% male) and 37 healthy individuals (52 ± 8 years; 51% male). In T2DM, resting aPWV was inversely associated with GMV (standardized β = −0.47, p = 0.036). In healthy participants, resting Pexcess was inversely associated with GMV (β = −0.23, p = 0.043) and AIx was associated with WML volume (β = 0.52, p = 0.021). There were no associations between exercise hemodynamics and brain volumes in either group.ConclusionsBrain atrophy is associated with resting aortic stiffness in T2DM, and resting Pexcess in healthy individuals. Central vascular mechanisms underlying structural brain changes may differ between healthy individuals and T2DM.

Arterial stiffness, endothelial and cognitive function in subjects with type 2 diabetes in accordance with absence or presence of diabetic foot syndrome

“…Another recent study [45] aimed to determine the associations between central hemodynamics and brain structure at rest and during exercise in people with and without T2DM, reporting that brain atrophy is associated with resting aortic stiffness in T2DM, and that central vascular mechanisms underlying structural brain changes may differ between healthy individuals and T2DM. These findings could also represent a further pathogenic issue of cognitive impairment in human subjects with a higher degree of arterial stiffness.…”

Aortic-to-brachial stiffness gradient and kidney function in type 2 diabetes

“…These abnormalities could alter ab-SG, and may help explain greater susceptibility to accelerated endorgan damage in these patients [9][10][11]. Studies from Hashimoto and Ito [12][13][14][15] show that increased aortic stiffness influences aortic and femoral haemodynamics such that renal artery blood flow is impaired and kidney function declines.…”

Effects of Exercise on Type 2 Diabetes Mellitus-Related Cognitive Impairment and Dementia

“…Insulin receptors are ubiquitously present in the brain, and neuronal insulin resistance is associated with impaired amyloid clearance [46] and increased tau phosphorylation [43,45]. Other potential targets include advanced glycation end products [47] and abnormal central hemodynamics [48]. The likelihood of multiple interacting or additive mechanisms that are prevalent in T2DM, as well as risk factors for dementia, calls for therapeutic approaches that can address more than just individual targets to reduce the risk of T2DM-related dementia.…”