Carotid-femoral pulse wave velocity is associated with cerebral white matter lesions in type 2 diabetes

Esben Laugesen, Pernille Høyem, Brian Stausbøl-Grøn, Anders Mikkelsen, Samuel Thrysøe, Mogens Erlandsen, Jens S Christiansen, Søren T Knudsen, Klavs W Hansen, Won Y Kim, Troels K Hansen, Per L Poulsen, Esben Laugesen, Pernille Høyem, Brian Stausbøl-Grøn, Anders Mikkelsen, Samuel Thrysøe, Mogens Erlandsen, Jens S Christiansen, Søren T Knudsen, Klavs W Hansen, Won Y Kim, Troels K Hansen, Per L Poulsen

Abstract

Objective: Patients with type 2 diabetes have a high incidence of cardiovascular events including stroke. Increased arterial stiffness (AS) predicts cardiovascular events in the general population. Cerebral white matter lesions (WMLs) are associated with an increased risk of stroke. It is unknown whether AS in patients with type 2 diabetes is associated with WMLs.

Research design and methods: We examined 89 patients recently diagnosed with type 2 diabetes (<5 years) and 89 sex- and age-matched controls. AS was assessed with carotid-femoral pulse wave velocity (PWV). WMLs were identified using magnetic resonance imaging and graded qualitatively with the Breteler scale (no/slight changes = 0, moderate changes = 1, severe changes = 2) and semiquantitatively.

Results: The diabetic population had excellent glycemic control (HbA(1c), 6.5% [6.2-6.8]; median [interquartile range {IQR}]) and had, compared with the controls, lower office blood pressure (BP) (127 ± 12/79 ± 8 vs. 132 ± 14/84 ± 10 mmHg) and total cholesterol (4.3[3.9-4.7] vs. 5.6 [5.1-6.4]; mmol/L; median [IQR]), (P < 0.01 for all). Despite this, PWV was higher in the patients with diabetes compared with controls (9.3 ± 2.0 vs. 8.0 ± 1.6 m/s; P < 0.0001). PWV was associated with Breteler score (OR 1.36 [95% CI 1.17-1.58]; P < 0.001) and WML volume (OR 1.32 [95% CI 1.16-1.51]; P < 0.001) per 1 m/s increase in PWV. These associations remained significant when adjusted for age, sex, diabetes, 24-h mean arterial BP, BMI, heart rate, and use of antihypertensives and statins (Breteler score: OR 1.28 [95% CI 1.03-1.60]; P < 0.05 and WML volume: OR 1.30 [95% CI 1.06-1.58]; P < 0.05).

Conclusions: PWV was higher among patients with well-controlled type 2 diabetes compared with controls and was independently associated with WMLs. PWV may represent a clinically relevant parameter in the evaluation of cerebrovascular disease risk in type 2 diabetes.

Trial registration: ClinicalTrials.gov NCT00674271.

Figures

Figure 1
Figure 1
PWV and BP in 89 patients with type 2 diabetes and 89 sex- and age-matched controls. A: PWV. B: Office systolic BP. C: 24-h ABPM. D: Night pulse pressure.
Figure 2
Figure 2
Box-and-whiskers plot of the association between PWV and Breteler score among all 178 subjects. P for trend is shown. The whiskers represent the highest value within 1.5 times the interquartile range (IQR) from the upper quartile and the lowest value within 1.5 times the IQR from the lower quartile.

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Source: PubMed

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