Arterial Stiffness Is Associated With Cardiovascular, Renal, Retinal, and Autonomic Disease in Type 1 Diabetes

Abstract

OBJECTIVEIn patients with type 1 diabetes, we investigated the association between arterial stiffness and diabetes complications.RESEARCH DESIGN AND METHODSThis was a cross-sectional study including 676 Caucasian patients with type 1 diabetes (374 [55%] men, aged 54 ± 13 years [mean ± SD]) and 51 nondiabetic controls (28 [55%] men, aged 47 ± 13 years). Aortic pulse wave velocity (PWV) was measured with SphygmoCor (AtCor Medical, Sydney, Australia) for 635 patients and all 51 controls.RESULTSPWVs (mean ± SD) in patients and controls were 10.4 ± 3.4 and 7.6 ± 1.9 m/s, respectively (P < 0.001). After multivariate adjustment, PWV correlated with age, diabetes duration, urinary albumin excretion rate, heart rate, and blood pressure (P < 0.05 for all). ANCOVA was used for comparisons between groups and adjusted for gender, age, estimated glomerular filtration rate, heart rate, HbA1c, and 24-h mean arterial pressure. PWVs in normoalbuminuric, microalbuminuric, and macroalbuminuric patients were 9.5 ± 3.2, 11.0 ± 3.6, and 11.4 ± 3.0 m/s, respectively (adjusted P < 0.001). PWV in patients with previous cardiovascular disease, versus patients without, was 12.1 ± 3.5 vs. 10.0 ± 3.2 m/s, respectively (adjusted P < 0.001). PWVs in patients with high (≥140/90 mmHg) versus intermediate (130–40/80–89 mmHg) and low (<130/80 mmHg) blood pressure were 11.8 ± 3.6, 10.0 ± 3.0, and 9.8 ± 3.3 m/s, respectively (adjusted P < 0.001). Furthermore, PWV increased with increasing degree of retinopathy: 8.0 ± 2.5 m/s (nil), 10.0 ± 2.8 m/s (simplex), 12.1 ± 3.5 m/s (proliferative), and 12.7 ± 2.4 m/s (blind), respectively (adjusted P < 0.001). Finally, PWV increased with abnormal heart rate variability: 11.5 ± 3.3 m/s vs. 10.1 ± 3.1 m/s (borderline) and 8.1 ± 2.1 m/s (normal) (adjusted P = 0.027).CONCLUSIONSArterial stiffness increased with presence and duration of type 1 diabetes. Furthermore, PWV increased with all the investigated diabetes complications (cardiovascular, renal, retinal, and autonomic disease) independently of other risk factors.

Adolescent Type 1 Diabetes Cardio-Renal Intervention Trial (AdDIT): Urinary Screening and Baseline Biochemical and Cardiovascular Assessments

“…Similarly, previous studies performed in populations of young people with type 1 diabetes mainly showed differences in cIMT or FMD when comparing subjects with and without microalbuminuria (23). Our results are also in line with data from adults with type 1 diabetes, where PWV was one of the first detectable vascular alterations in those with microalbuminuria and macroalbuminuria (24). Increased PWV has emerged as a predictor of future CV events and mortality (24).…”

“…Our results are also in line with data from adults with type 1 diabetes, where PWV was one of the first detectable vascular alterations in those with microalbuminuria and macroalbuminuria (24). Increased PWV has emerged as a predictor of future CV events and mortality (24). The vascular reassessment at the end of AdDIT will test the hypothesis that PWV evolution at a very young age can be modified through early treatment with ACEIs and statins, both alone and in combination.…”

The Relationship between Vascular Function and the Autonomic Nervous System

“…87) In addition, in a cohort of young, type 1 diabetic subjects without a history of hypertension and any evidence of macrovascular disease, subjects with a high cardiac autonomic neuropathy score had signifi cantly higher pulse wave velocity compared with subjects with a low score, and a negative correlation between pulse wave velocity and heart rate variation was observed. 88) These fi ndings may help to explain the high cardiovascular mortality seen in diabetic subjects with autonomic neuropathy. 87) Indeed, impaired cardiac autonomic control is statistically signifi cantly related to the development of ischemic heart disease among individuals with diabetes, independent of markers of the duration/severity of glucose metabolism impairments.…”

The relationship between nephropathy, retinopathy, obesity and arterial stiffness in type 2 diabetes mellitus

“…In the study of Theilade et al [18] a positive correlation between PWV and excretion ratio was found. Also it was seen in the same study that in normoalbuminuric type 1 DM patients, PWV was relatively high in comparison to control group.…”

“…[17] In this study a statistically positive relation was diagnosed between PWV and type 2 DM duration, HDL, SBP, MAP values. In a study by Theilade et al [18] in type 1 DM patients, a positive correlation (r=0.54) between PWV and diabetes duration was seen. In a study by Cruickshank et al [19] it was seen that as glucose tolerance fell, PWV values rose.…”