Vascular Compliance Is Reduced in the Early Stages of Type 1 Diabetes

Abstract

OBJECTIVE -To determine whether arterial compliance of patients with type 1 diabetes is reduced before the development of clinically apparent diabetes complications.RESEARCH DESIGN AND METHODS -Pulse-wave analysis was used to compare vascular compliance between patients with type 1 diabetes and nondiabetic control subjects. Analysis of covariance was used to determine differences between the two groups with adjustment for age if needed.RESULTS -A total of 59 patients with type 1 diabetes were studied; age ranged from 17-61 years. Of the 59 patients, 32 had no evidence of diabetes complications and 27 had microvascular complications. The control group consisted of 57 healthy subjects ranging in age from 23-79 years. In the control group, large artery compliance (C1) and small artery compliance (C2) were inversely proportional to age (r ϭ Ϫ0.55 for C1 and Ϫ0.50 for C2; P Ͻ 0.01). When the control subjects were compared with type 1 diabetic patients without microvascular complications, C1 was 1.51 Ϯ 0.04 (SEM) for the control group and 1.33 Ϯ 0.06 (SE) ml/mmHg for the diabetic group, whereas C2 was 0.080 Ϯ 0.005 (SE) and 0.065 Ϯ 0.005 (SE) ml/mmHg for the control and diabetic subjects, respectively, when adjusted for age (P ϭ 0.03 for both C1 and C2).CONCLUSIONS -Vascular compliance of both the large and small arteries is reduced in type 1 diabetic patients before any clinical complications from the diabetes are evident. This study serves to emphasize that vascular changes occur at an early point in the disease and may increase risk of cardiovascular events in patients with diabetes. Larger prospective studies are required to confirm this finding and to investigate the efficacy of medical intervention. Diabetes Care 24:2102-2106, 2001H ypertension, hypercholesterolemia, and diabetes are well-recognized cardiovascular risk factors (1). Emerging evidence suggests that decreased vascular elasticity and storage capacity of the vessels, also known as vascular compliance, is associated with each of these conditions and may predispose patients to cardiovascular events (2,3). A reduction in arterial compliance is a marker for vascular disease and should prompt a more aggressive approach in managing cardiovascular risk factors (3-6). Several studies have demonstrated diminished arterial compliance in patients with type 1 or type 2 diabetes, which may contribute, in part, to the excess cardiovascular morbidity and mortality associated with these conditions (7-11).Noninvasive technology has enabled the measurement of pulse wave velocity and arterial pulse contour to assess vascular compliance (12,13). Doppler ultrasound has been used to measure pulsewave velocity and aortic compliance, but this method is operator-dependent and more prone to error (12). In addition, Doppler techniques only assess large arteries because measurements are taken from the aorta or the aorta-iliac junction (12). Pulse-wave contour analysis is a reproducible and objective method for determining compliance of both the large and small arteries by using...

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