Brachial-Ankle Pulse Wave Velocity Is Useful for Evaluation of Complications in Type 2 Diabetic Patients

Lee

et al. 2011

JAT

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.

Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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

Lee

et al. 2011

JAT

“…In the present study, we also found that serum IL-18 levels were positively correlated with carotid IMT and baPWV in patients with type 2 diabetes. Several studies have reported that carotid IMT (11,12) and baPWV (31) are useful markers for evaluation of atherosclerosis in type 2 diabetes. A clinical study reported that decrease in glomerular filtration rate is linked to atherosclerosis (32).…”

Section: Il-18 Is a Predictor Of Diabetic Nephropathymentioning

confidence: 99%

Serum Interleukin-18 Levels Are Associated With Nephropathy and Atherosclerosis in Japanese Patients With Type 2 Diabetes

et al. 2005

OBJECTIVE -Interleukin (IL)-18 is a proinflammatory cytokine secreted from mononuclear cells. Serum concentration of IL-18 is a strong predictor of death in patients with cardiovascular diseases. Recent studies have shown that microinflammation is involved in the pathogenesis of diabetic nephropathy as well as of cardiovascular diseases. This study aimed to test the hypothesis that the serum level of IL-18 is a common predictor of nephropathy and atherosclerosis in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -Eighty-two Japanese patients with type 2 diabetes and 55 age-and sex-matched healthy control subjects were enrolled. Patients with renal dysfunction (creatinine clearance Ͻ1 ml/s) were excluded. We assessed clinical parameters and measured serum and urinary IL-18 levels, serum IL-6 levels, carotid intima-media thickness (IMT), and brachial-ankle pulse wave velocity (baPWV) in all patients. Further, we evaluated changes of urinary albumin excretion rate (AER) after 6 months in 76 diabetic patients.RESULTS -Serum and urinary IL-18 levels were significantly elevated in patients with type 2 diabetes as compared with control subjects (serum IL-18 179 Ϯ 62 vs. 121 Ϯ 55 pg/ml, P Ͻ 0.001; urinary IL-18 97 Ϯ 159 vs. 47 Ϯ 54 pg/ml, P ϭ 0.035). Univariate linear regression analysis showed significant positive correlations between serum IL-18 and AER (r [correlation coefficient] ϭ 0.525, P Ͻ 0.001), HbA 1c (r ϭ 0.242, P ϭ 0.029), high-sensitivity C-reactive protein (hs-CRP) (r ϭ 0.240, P ϭ 0.031), and urinary ␤-2 microglobulin (r ϭ 0.235, P ϭ 0.036). Serum IL-18 levels also correlated positively with carotid IMT (r ϭ 0.225, P ϭ 0.042) and baPWV (r ϭ 0.232, P ϭ 0.040). We also found a significant correlation between urinary IL-18 and AER (r ϭ 0.309, P ϭ 0.005). Multivariate linear regression analysis showed that AER (standard correlation coefficients [B] ϭ 0.405, P Ͻ 0.001) and hs-CRP (B ϭ 0.207, P ϭ 0.033) were independently associated with serum IL-18 levels. AER was also independently associated with urinary IL-18 levels (B ϭ 0.295, P ϭ 0.005). Moreover, serum and urinary IL-18 levels correlated positively with AER after 6 months (r ϭ 0.489, P Ͻ 0.001 and r ϭ 0.320, P ϭ 0.005) and changes in AER during the follow-up period (r ϭ 0.268, P ϭ 0.018 and r ϭ 0.234, P ϭ 0.042).CONCLUSIONS -Serum levels of IL-18 might be a predictor of progression of diabetic nephropathy as well as cardiovascular diseases. Diabetes Care 28:2890 -2895, 2005L ow-grade inflammation (microinflammation) occurs in diabetic patients as well as those with cardiovascular diseases (1,2). Several reports indicate that high-sensitivity C-reactive protein (hs-CRP) (3) and proinflammatory cytokines such as interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-␣, and IL-18 are elevated in patients with type 2 diabetes (4 -7). The mechanisms for elevation of serum IL-18 levels in type 2 diabetes remain unclear, although oxidative stress is a candidate (8). Activation of nuclear factor-B through oxidative stress induced by hyperglycemia increas...

“…To estimate the effect of increasing steps/day during the study, ∆steps/day was calculated using the following formula 20) : ∆steps/day = ∑{(steps/day at Week X) -(steps/day at Week 0)} *(X=1- 16) To evaluate change in baPWV, we set a cut-off baPWV = 1,700 cm/s. Although there is no clear cut-off value of baPWV that defines organ disorders 21) , this value is a predictor of several health disorders such as all mortality 22) , type 2 diabetes mellitus 23) , cerebral ischemic small vessel disease 24) and acute coronary syndrome 25) . Each subject was categorized as either 'high' or 'low' according to his or her starting baPWV above or below the cut-off value.…”

Section: Discussionmentioning

confidence: 99%

Relationship Between the Change in Daily Step Count and Brachial-Ankle Wave Velocity During a Pedometer-Based Physical Activity Program for Older Adults

et al. 2011

Objective: To study the relationship between the change in the number of steps taken and brachial-ankle pulse wave velocity (baPWV) during a long-term pedometer-based physical activity program in healthy older adults. Methods: Sixty older adults participated in this 17-week program. Each subject was provided with a pedometer and was given a goal to walk a set number of steps/day. After five subjects were excluded because of insufficient step data, data from 55 subjects (19 men and 36 women; age range: 65-79 years, mean age: 71.3±3.7 years; mean body mass index [BMI]: 24.1±8.8 kg/m 2 ) were analyzed. Subjects were checked before and after the study. Each subject was informed of his or her vascular age, calculated from baPWV, at the start of the study. Results: Subjects were divided into four groups based on the results of baPWV. The group in which baPWV improved above a selected cut-off value (1,700 cm/s) revealed the largest increase in steps/day among groups. This increase (4837.7±1868.7 steps) was larger than in groups in which baPWV remained low (1406.7±2402.1 steps, p=0.036) and high (1678.2±2871.4 steps, p=0.059). In any group, age or initial steps/day did not influence the change in steps. Subjects classified as having an older vascular age than the actual age on the basis of initial baPWV walked further. Conclusion: An increase in steps/day might improve baPWV. Although walking is a low intensity physical activity, it can have an anti-atherosclerosis effect.