Flow-Mediated Dilation is Associated with Microalbuminuria Independent of Cardiovascular Risk Factors in Type 2 Diabetes

Yokoyama, Hiroyuki; Sone, Hirohito; Saito, Kazumi; Yamada, Daishiro; Honjo, Jun; Haneda, Masakazu

doi:10.5551/jat.7526

Cited by 28 publications

(25 citation statements)

References 32 publications

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“…In accordance with our findings previously reported data have not shown an association of glycemic control with endothelial dysfunction [31,33]. On the other hand, endothelial dysfunction has been previously related to the presence and levels of cardiovascular risk factors in T2DM patients [23,29,30], although not consistently [34], while vascular inflammation has been suggested to play a central role in the development of endothelial dysfunction [35]. It should be noted that compared to other reports [23,29,30], our study included T2DM patients with severely impaired FMD (mean FMD 1.98%) and a high prevalence of accumulated cardiovascular risk factors; in these patients longer duration of diabetes, and not other established cardiovascular risk factors, was the only important determinant of endothelial dysfunction.…”

Section: Discussionsupporting

confidence: 92%

“…In T2DM patients without macrovascular or microvascular disease, we found that endothelial dysfunction, as assessed by reduced brachial artery FMD, was independently associated only with the duration of diabetes; for every 10 years of diabetes, FMD is reduced by approximately 1.0% (in absolute FMD values). Previous studies have shown significant associations of FMD with diabetes duration [29,30] although not consistently [31]. Longer T2DM duration has also been shown to increase CVD risk and total mortality significantly even after adjustment for established and novel cardiovascular risk factors [32] suggesting that there might be a link between T2DM duration, worsening endothelial function and cardiovascular prognosis in these patients.…”

Section: Discussionmentioning

confidence: 95%

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Determinants of vascular function in patients with type 2 diabetes

Naka

Papathanassiou

Bechlioulis

et al. 2012

Cardiovasc Diabetol

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BackgroundType 2 diabetes mellitus (T2DM) is independently associated with an increased risk for cardiovascular diseases that is primarily due to the early development of advanced atherosclerotic vascular changes. The aim of our study was to investigate the predictors of vascular dysfunction in T2DM patients.MethodsWe studied 165 T2DM patients without known macrovascular or microvascular disease. Standard demographic (age, gender, cardiovascular risk factors, medications), clinical (body mass index, blood pressure) and laboratory (glucose, glycated hemoglobin, lipids, renal function) parameters were included in analyses. Brachial artery flow-mediated dilation (FMD), nitrate mediated dilation (NMD) and Carotid-Femoral Pulse Wave Velocity (PWV) were measured.ResultsMedian age was 66 years and duration since T2DM diagnosis was 10 years, 70% were females and 79% hypertensives, while only 10% had a glycated hemoglobin <7%. FMD was positively associated with NMD (r 0.391, P < 0.001), while PWV was inversely associated with FMD (r -0.218, P = 0.014) and NMD (r -0.309, P < 0.001). Time since diagnosis of diabetes was the single independent predictor of FMD (β -0.40, P = 0.003). Increased age and fasting glucose and the presence of hypertension were independent predictors of decreased NMD (P < 0.001). Increased age and systolic blood pressure were independently associated with increased PWV (P < 0.001).ConclusionsIn T2DM patients, impairment of endothelium-dependent vasodilation was independently associated only with longer diabetes duration while no association with other established risk factors was found. Vascular smooth muscle dysfunction and increased arterial stiffness were more prominent in older T2DM patients with hypertension. Worse glycemic control was associated with impaired vascular smooth muscle function.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

Determinants of vascular function in patients with type 2 diabetes

Naka

Papathanassiou

Bechlioulis

et al. 2012

Cardiovasc Diabetol

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“…Although the relationships between MAU and endothelial dysfunction, as well as with impaired endothelial function in hypertensive patients with CP, have been investigated in several studies, 3,4) the superposition of two OD parameters such as MAU and CP in association with endothelial function remains unclear.…”

mentioning

confidence: 99%

The Role of Microalbuminuria in Arterial Endothelial Dysfunction in Hypertensive Patients With Carotid Plaques

Lin

Zhang

et al. 2014

Int. Heart J.

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SummaryThe aim of this study was to evaluate the correlations between microalbuminuria (MAU) and endothelial function in hypertensive patients with carotid plaques (CP). A total of 71 hypertensive patients with CP (CP group) and 20 healthy people as normal controls (NC group) were enrolled in this study. The CP group was divided into an MAU group (MAU group, n = 33) and a non-microalbuminuria group (NM group, n = 38) according to their urinary albumin excretion rates (UAER). Endothelial function was assessed by fl ow-mediated dilation (FMD) in the brachial artery by ultrasonography, and nitroglycerin-mediated dilation (NMD) was used as a control test for FMD. Intima-media thickness (IMT) and biochemical parameters were evaluated. The ΔFMD% was signifi cantly lower in patients with and without MAU in the CP group compared to the NC group. All patients with MAU had signifi cantly lower ΔFMD% and ΔNMD% compared to the patients without MAU. ΔFMD% showed signifi cant negative correlations with IMT, systolic blood pressure, glucose, total cholesterol, low density lipoprotein, high-sensitivity C-reactive protein, and log UAER. ΔNMD% demonstrated signifi cant negative correlations with age, IMT, systolic blood pressure, glucose, and log UAER. Stepwise multiple linear regression analysis revealed that FMD was independently correlated with UAER and total cholesterol, while NMD was independently correlated with UAER and age. These results suggest that MAU might aggravate the arterial dysfunction and play a role in the arterial endothelial function in patients with hypertension and CP. Both endothelium-dependent and endothelium-independent vasodilatations were impaired in hypertensive patients with CP. ( 2) It is noteworthy that the risk increases as the number of damaged organs increases. Although the relationships between MAU and endothelial dysfunction, as well as with impaired endothelial function in hypertensive patients with CP, have been investigated in several studies, 3,4) the superposition of two OD parameters such as MAU and CP in association with endothelial function remains unclear.Carotid plaque-induced endothelial dysfunction is also indicated as a predictor for CVD events. 1) A recent study has found that vascular endothelium impairment, which is a key initial step in atherogenesis, 5) is also associated with hypertension, 6) and endothelial dysfunction is common in subjects with cardiovascular risk factors.7) Endothelial function can be assessed by fl ow-mediated dilation (FMD). Nitroglycerin-mediated dilation (NMD) has been used as a control test for FMD when evaluating endothelial function in humans. 8) FMD is an endothelium-dependent response while NMD is an endothelium-independent response. FMD is dependent on local nitric oxide (NO) bioavailability, and NMD is dependent on exogenous NO (eg, nitroglycerin). Both are well-established methods for noninvasive assessment of vascular function. 9) Recently, a few studies have demonstrated that not only FMD but also NMD is impaired in patients with atheroscler...

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“…25) Benidipine has been reported to improve vascular endothelial function in basic and clinical research. 10,26) Our study suggested that benidipine might be superior to amlodipine in improving AI and UAE, which may be accounted for by the vascular protective effects of benidipine, including improvement in vascular endothelial function.…”

Section: Discussionmentioning

confidence: 99%

Improvements in Augmentation Index and Urinary Albumin Excretion With Benidipine in Hypertensive Patients With Chronic Kidney Disease

et al. 2016

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SummaryAlthough calcium channel blockers (CCB) are expected to improve the augmentation index (AI) in CKD patients, the potential effect of benidipine on AI has been poorly studied.The present study aimed to compare the effect of benidipine and amlodipine in the treatment of CKD patients as measured through AI and urinary albumin excretion (UAE). Eligible patients with CKD were randomized to either the benidipine group or amlodipine group. Changes in UAE and AI were compared with target blood pressure level set at < 130/80 mmHg. A total of 108 patients were enrolled; 88 patients who were followed up were included in the analysis. Although no significant change in renal function was noted in either group, there was a significant improvement in AI only in the benidipine group (85.7 ± 13.3% to 81.4 ± 15.2%; P = 0.021) A subgroup analysis of 64 patients who achieved SBP < 140 mmHg at the end of follow-up (31 on amlodipine and 33 on benidipine) was carried out. Significant improvement in AI was noted only in the benidipine group (84.5 ± 13.6% to 79.5 ± 15.2%; P = 0.0138). In another subgroup of patients with UAE ≥ 300 mg/g Cr, a significant improvement in UAE in the benidipine group was found compared with the amlodipine group (-25 ± 46, 51 ± 60%, P = 0.031, respectively).These results suggest that benidipine might reduce significantly AI and might have potentially greater improvements in UAE than amlodipine in advanced CKD patients receiving RAS inhibitors. (Int Heart J 2016; 57: 53-60)

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Flow-Mediated Dilation is Associated with Microalbuminuria Independent of Cardiovascular Risk Factors in Type 2 Diabetes

Abstract: Aims:To investigate whether endothelial dysfunction assessed by brachial artery flow-mediated dilation (FMD) is associated with urinary albumin excretion (UAE) and is interrelated with carotid intima-media thickness (IMT) and pulse-wave velocity (PWV) in type 2 diabetes.

Cited by 28 publications

References 32 publications

Determinants of vascular function in patients with type 2 diabetes

Determinants of vascular function in patients with type 2 diabetes

The Role of Microalbuminuria in Arterial Endothelial Dysfunction in Hypertensive Patients With Carotid Plaques

Improvements in Augmentation Index and Urinary Albumin Excretion With Benidipine in Hypertensive Patients With Chronic Kidney Disease

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