Arterial Stiffness: Its Relation with Prediabetes and Metabolic Syndrome and Possible Pathogenesis

Abstract

Aims: To evaluate arterial stiffness indicators in people with prediabetes (PreD) and its possible pathogenesis. Materials and methods: Pulse wave velocity (PWV) was measured in 208 people with FINDRISC ≥ 13 (57 ± 8 years old, 68.7% women) and thereafter divided into those having either normal glucose tolerance (NGT) or PreD. In each subgroup we also identified those with/out insulin resistance (IR) measured by the triglyceride/HDL-c ratio (normal cut off values previously established in our population). Clinical and metabolic data were collected for all participants. PWV was compared between subgroups using independent t test. Results: Women and men had comparable clinical and metabolic characteristics with obesity (BMI ≥ 30) and antihypertensive-statin treatment, almost half with either NGT or PreD. Whereas 48% of NGT people presented IR (abnormally high TG/HDL-c ratio), 52% had PreD. PWV was significantly higher only in those with a complete picture of metabolic syndrome (MS). Conclusions: Since PWV was significantly impaired in people with a complete picture of MS, clinicians must carefully search for early diagnosis of this condition and prescribe a healthy life-style to prevent development/progression of CVD. This proactive attitude would provide a cost-effective preventive strategy to avoid CVD’s negative impact on patients’ quality of life and on health systems due to their higher care costs.

Arterial Stiffness Assessment by Pulse Wave Velocity in Patients with Metabolic Syndrome and Its Components: Is It a Useful Tool in Clinical Practice?

“…As proved in the cited literature as well as a study performed by Gagliardino, PWV is significantly impaired in patients with complete pictures of MS. Furthermore, the level of PWV is significantly increasing with the increasing number of MS components, supporting the need for careful research for the early diagnosis of CVD in patients with MS as a cost-effective preventive strategy [ 101 , 102 ]. Moreover, higher glucose levels in the prediabetic range and IR might lead to higher AS and concentric remodeling of the heart muscle [ 103 ].…”

Prediabetes, Non-Dipping Profile and Hypertension—A Recipe for Increased Arterial Stiffness

“…If we consider that higher PWV equals higher CV risk (TOD), then patients with PreD and non-dipping profiles in all hypertensive groups had the highest CV risk than all other subjects, which increases with aging [ 9 , 30 , 31 ]. Knowing that 9 to 50% of persons with PreD will develop T2DM in five years and 70% in ten years, the CV risk will additionally increase, because of which we have to start treating PreD and all CV risk factors immediately [ 32 , 33 ].…”

Glucemia en ayunas entre 100 y 109 mg/dL versus prediabetes según hemoglobina glicosilada

“…El criterio fundamental sobre el cual se sostiene la división entre estos tres niveles (normalidad, prediabetes y DM) es la afirmación respecto de que la retinopatía diabética (RD), tomada como parámetro diagnóstico objetivo de DM, aparecería por encima de los umbrales glucémicos y de HbA1c establecidos por la ADA, la EASD y la OMS. Pero diferentes autores ofrecen evidencia en relación a que tanto para la micro como para la macroangiopatía no pueden establecerse claramente umbrales de riesgo para sufrir complicaciones crónicas, al menos en las poblaciones estudiadas; personas con TGA y/o GAA tienen un alto riesgo no solo de desarrollar DM, sino también de experimentar eventos cardiovasculares (ECV), los cuales son causa del 80% de las muertes en este grupo 12,13 .…”