Associations Between Cardio-Ankle Vascular Index and Microvascular Complications in Type 2 Diabetes Mellitus Patients

Abstract

Aim: Type 2 diabetes mellitus (T2DM) is a risk factor for increased arterial stiffness. We evaluated associations between the cardio-ankle vascular index (CAVI) and carotid plaque, intima media thickness (IMT), and diabetic microvascular complications in Korean T2DM patients. Methods: We conducted a retrospective, cross-sectional study of 320 Korean T2DM patients without a history of macrovascular disease or macroalbuminuria. We measured 24-hour urinary albumin excretion (UAE) levels and performed funduscopic and neuropathy examinations to assess the extent of diabetic microvascular complications. Arterial stiffness was assessed using CAVI. We also measured the ankle-brachial index (ABI), common carotid artery IMT, and carotid beta stiffness index. Results: Among the 320 patients enrolled in this study, 64 (20%) had increased CAVI (≥ 9). We found that CAVI was correlated with systolic blood pressure, pulse pressure, IMT, carotid beta stiffness index, log-transformed UAE, and total cholesterol. In multiple logistic regression analysis, mean IMT and the presence of carotid plaque were independently associated with increased CAVI (≥ 9) (OR 5.77, P 0.01; OR 5.36, P 0.001, respectively). Furthermore, an increased CAVI was associated with peripheral neuropathy (OR 2.03, P 0.03) and microalbuminuria (OR 2.47, P 0.01) after adjusting for possible confounding variables. Conclusions:The results of this study suggest that increased CAVI is associated with the presence of arterial plaque, increased IMT, and microvascular complications, such as nephropathy and neuropathy, in T2DM patients. J Atheroscler Thromb, 2011; 18:328-336.

Stroke patients with cerebral microbleeds on MRI scans have arteriolosclerosis as well as systemic atherosclerosis

“…Moreover, previous studies have established a strong association between the CAVI and small-vessel disease of other organs. 23,24 Kubozono et al 23 reported a relationship between the CAVI and a low estimated glomerular filtration rate. Kim et al 24 identified a correlation between the CAVI and microvascular complications in type 2 diabetes mellitus patients without a history of macrovascular disease.…”

“…23,24 Kubozono et al 23 reported a relationship between the CAVI and a low estimated glomerular filtration rate. Kim et al 24 identified a correlation between the CAVI and microvascular complications in type 2 diabetes mellitus patients without a history of macrovascular disease. The CAVI may thus be a marker of small-vessel disease of various organs, including the brain.…”

Relationships between Nocturnal Intermittent Hypoxia, Arterial Stiffness and Cardiovascular Risk Factors in a Community-based Population: The Toon Health Study

“…The hypoxia, hypercapnia and pressure surges accompanying intermittent hypoxia events may also serve as potent stimuli for the release of vasoactive substances, leading to impairment of the endothelial function. Moreover, a low oxygen level is a trigger for the activation of neutrophils, which adhere to the endothelium ), physical activity (mets · hr/day), smoking (y/n), alcohol consumption (y/n), hypertension (y/n), DM (y/n), and hyperlipidemia (y/n) Furthermore, we used the CAVI, a reliable, reproducible and novel marker of arterial stiffness 26,31) . Limitations of this study include the fact that the cross-sectional design cannot be used to establish causality between NIH, arterial stiffness and an overweight status.…”

“…Patients with a CAVI of ≥ 9 have been reported to present with significantly higher mean and maximum intima-media thicknesses, carotid beta stiffness indices and levels of carotid plaque 31) . Furthermore, it has been reported that a cut-off CAVI value of 8.81 yields maximum sensitivity and specificity for detecting coronary artery disease.…”

“…Furthermore, it has been reported that a cut-off CAVI value of 8.81 yields maximum sensitivity and specificity for detecting coronary artery disease. We therefore defined increased arterial stiffness in this study as an abnormal CAVI (≥ 9), as applied in previous studies 31,32) . Further theoretical details of the CAVI method are described elsewhere 26) .…”