Physical Aerobic Supervised Training Improves Endothelial and Microcirculatory Resistance to Oxidative Stress in Peripheral Arterial Disease

Abstract

Introduction: Diabetes mellitus is characterised by a clearcut progression with time of carotid artery wall thickness and atherosclerosis show, its magnitude being attenuated by blood pressure lowering interactions including those based on the effect of ACE inhibition. Limited information is available on the effect of ACE inhibition on carotid thickening in diabetic patients with no other risk factors kept under effective strict metabolic control by treatment. Methods: This was a double blind study on 47 normotensive normolipaemic patients with a IDDM ( mean duration of disease 13±6 years, mean ±SD) who were studied if 1) there was no evidence of micro and macrovascular implications and 2) insulin treatment and clinical conditions were stable. Patients were randomised to Quinapril (Q, n=24) or placebo (P, n=23) and kept on treatment for 24 months. Intensive life style modifications were implemented in both groups by means of frequent visits (every 4 weeks). Measurements were made at randomisation as well as after 13 weeks and 24 months of treatment and consisted of carotid IMT by echo colour Doppler, office and 24 hour ambulatory blood pressure and lipid and glucose metabolic variables. Results: Age was similar in the Q and P groups (37.2±vs 35.8±6.8 years) which also showed no significant between group differences, as baseline office blood pressure (124±11/80±6 vs 123±13/ 77±8 mmHg) mean 24 hour blood pressure (127±9/78±8 vs 128±7/79±6 mmHg), serum total cholesterol (172±26 vs 183±34 mg/dl) and serum triglycerides (76±30 vs 80±63 mg/dl) values. Baseline glycated haemoglobin was not significantly different in the two groups (7.8±1.1 vs 7.8±1.1%), this being the case also for fasting blood glucose (158±51 vs 180± 68 mg/dl). Baseline IMT was 0.47± 0.10 mm in the placebo group and 0.46±0.16 in the Q group. Neither after 13 weeks nor after 2 years Q or P administration was associated with significant alterations in office or ambulatory blood pressure, lipid variables, fasting blood glucose and glycated haemoglobin. In the P group IMT remained unchanged both after 3 mouths and after 2 years (0.47±0.12 mm and 0.47 ±0.12 respectively) whereas in the Q group it showed a modest reduction (0.41±0.1 and 0.44 ±0.15mm) which was statistically significant only after 3 months (p<0.01). Conclusions: In uncomplicated, normotensive, normolipaemic patients with type I diabetes mellitus under effective glycaemic control, long term progression of carotid artery wall thickness can be prevented with only additional small benefit by ACE inhibition.