Impact of diabetes mellitus on arterial stiffness in a representative sample of an urban Brazilian population

Rafael de Oliveira Alvim, Paulo Caleb Junior Lima Santos, Mariane Manso Musso, Roberto de Sá Cunha, José Eduardo Krieger, José Geraldo Mill, Alexandre Costa Pereira, Rafael de Oliveira Alvim, Paulo Caleb Junior Lima Santos, Mariane Manso Musso, Roberto de Sá Cunha, José Eduardo Krieger, José Geraldo Mill, Alexandre Costa Pereira

Abstract

Background: Independent of other cardiovascular (CV) risk factors, increased arterial stiffness has been established as a predictor of morbidity and mortality. The main aim of this study was to investigate the impact of diabetes on arterial stiffness in a representative sample of an urban Brazilian population plus Amerindians.

Methods: A total of 1,415 individuals from the general population were randomly selected plus 588 Amerindians from a native community in Brazil. In addition, a sub-sample of 380 individuals from the general population had 5-year follow-up data. Pulse wave velocity (PWV) was measured with a non-invasive automatic device (Complior, Colson; Garges les Gonesses, France) and increased arterial stiffness was defined as PWV ≥ 12 m/s.

Results: In the overall group, diabetic individuals had higher frequencies of increased arterial stiffness and hypertension. They also had higher values of PWV, body mass index, total cholesterol, triglycerides, systolic and diastolic blood pressures compared to non-diabetic individuals (p < 0.01). In an analysis stratified by hypertension, PWV values and increased arterial stiffness frequency were higher in diabetic individuals in both groups (hypertensive and non-hypertensive) (p < 0.05). Furthermore, higher risk for increased arterial stiffness was observed in the diabetic individuals from the overall group (OR = 2.27; CI = 1.47-3.52, p < 0.001) and from the hypertensive group (OR = 2.70; CI = 1.58-4.75, p < 0.001), adjusted for covariates. Regarding the ethnic stratification, diabetic individuals from Amerindian, White, and Mulatto (mixed-race) groups had higher PWV values and a greater frequency of increased arterial stiffness compared to non-diabetic individuals. Both diabetic and non-diabetic individuals had higher PWV values after 5 years. There was no significant difference in the 5-year PWV progression in diabetic compared to non-diabetic individuals.

Conclusions: These results confirm, in a sample of Brazilian population, that the presence of diabetes is associated with increased arterial stiffness and it may contribute in part to increased cardiovascular risk in diabetic patients.

Figures

Figure 1
Figure 1
Logistic model arterial stiffness odds ratio using diabetes mellitus and hypertension phenotypes. Increased arterial stiffness = pulse wave velocity ≥ 12m/s. Diabetes mellitus and hypertension phenotypes are categorized as 0 (non-diabetic and non-hypertensive group), 1 (diabetic and non-hypertensive group; p = 0.02), 2 (non-diabetic and hypertensive group; p < 0.001), and 3 (diabetic and hypertensive group; p < 0.001).
Figure 2
Figure 2
PWV values in a 5-year follow-up to the diabetes. The dotted line represents the individuals with diabetes (n = 25) and the solid line represents individuals without diabetes (n = 355) during the follow-up. PWV (pulse wave velocity) are expressed as mean ± standard deviation. Analysis of PWV was performed by paired samples t test repeated measures.

References

    1. Arnett DK, Evans GW, Riley WA. Arterial stiffness: a new cardiovascular risk factor? Am J Epidemiol. 1994;140(8):669–682.
    1. Meaume S, Benetos A, Henry OF, Rudnichi A, Safar ME. Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age. Arterioscler Thromb Vasc Biol. 2001;21(12):2046–2050. doi: 10.1161/hq1201.100226.
    1. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37(5):1236–1241. doi: 10.1161/01.HYP.37.5.1236.
    1. Laurent S, Katsahian S, Fassot C, Tropeano AI, Gautier I, Laloux B, Boutouyrie P. Aortic stiffness is an independent predictor of fatal stroke in essential hypertension. Stroke. 2003;34(5):1203–1206. doi: 10.1161/01.STR.0000065428.03209.64.
    1. Mattace-Raso FU, van der Cammen TJ, Hofman A, van Popele NM, Bos ML, Schalekamp MA, Asmar R, Reneman RS, Hoeks AP, Breteler MM. et al.Arterial stiffness and risk of coronary heart disease and stroke: the Rotterdam Study. Circulation. 2006;113(5):657–663. doi: 10.1161/CIRCULATIONAHA.105.555235.
    1. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55(13):1318–1327. doi: 10.1016/j.jacc.2009.10.061.
    1. Zoungas S, Asmar RP. Arterial stiffness and cardiovascular outcome. Clin Exp Pharmacol Physiol. 2007;34(7):647–651. doi: 10.1111/j.1440-1681.2007.04654.x.
    1. Vaitkevicius PV, Fleg JL, Engel JH, O’Connor FC, Wright JG, Lakatta LE, Yin FC, Lakatta EG. Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation. 1993;88(4 Pt 1):1456–1462.
    1. Stewart AD, Jiang B, Millasseau SC, Ritter JM, Chowienczyk PJ. Acute reduction of blood pressure by nitroglycerin does not normalize large artery stiffness in essential hypertension. Hypertension. 2006;48(3):404–410. doi: 10.1161/01.HYP.0000237669.64066.c5.
    1. Whincup PH, Gilg JA, Donald AE, Katterhorn M, Oliver C, Cook DG, Deanfield JE. Arterial distensibility in adolescents: the influence of adiposity, the metabolic syndrome, and classic risk factors. Circulation. 2005;112(12):1789–1797. doi: 10.1161/CIRCULATIONAHA.104.532663.
    1. Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation. 2001;103(7):987–992. doi: 10.1161/01.CIR.103.7.987.
    1. De Angelis L, Millasseau SC, Smith A, Viberti G, Jones RH, Ritter JM, Chowienczyk PJ. Sex differences in age-related stiffening of the aorta in subjects with type 2 diabetes. Hypertension. 2004;44(1):67–71. doi: 10.1161/01.HYP.0000130482.81883.fd.
    1. Stehouwer CD, Henry RM, Ferreira I. Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease. Diabetologia. 2008;51(4):527–539. doi: 10.1007/s00125-007-0918-3.
    1. Stehouwer CD. Diabetes, Lipids and Other Risk Factors. London: Elsevier; 2006.
    1. Cameron JD, Cruickshank JK. Glucose, insulin, diabetes and mechanisms of arterial dysfunction. Clin Exp Pharmacol Physiol. 2007;34(7):677–682. doi: 10.1111/j.1440-1681.2007.04659.x.
    1. Creager MA, Luscher TF, Cosentino F, Beckman JA. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: Part I. Circulation. 2003;108(12):1527–1532. doi: 10.1161/01.CIR.0000091257.27563.32.
    1. Tunstall-Pedoe H, Kuulasmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994;90(1):583–612. doi: 10.1161/01.CIR.90.1.583.
    1. Alvim RO, Freitas SR, Ferreira NE, Santos PC, Cunha RS, Mill JG, Krieger JE, Pereira AC. APOE polymorphism is associated with lipid profile, but not with arterial stiffness in the general population. Lipids Health Dis. 2010;9:128. doi: 10.1186/1476-511X-9-128.
    1. Lessa I. Fonseca J: [Race, compliance to treatment and/or consultation and control of arterial hypertension] . Arq Bras Cardiol. 1997;68(6):443–449.
    1. Pereira AC, Sposito AC, Mota GF, Cunha RS, Herkenhoff FL, Mill JG, Krieger JE. Endothelial nitric oxide synthase gene variant modulates the relationship between serum cholesterol levels and blood pressure in the general population: new evidence for a direct effect of lipids in arterial blood pressure. Atherosclerosis. 2006;184(1):193–200. doi: 10.1016/j.atherosclerosis.2005.03.035.
    1. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III) JAMA. 2001;285(19):2486–2497. doi: 10.1001/jama.285.19.2486.
    1. Santos PC, Oliveira TG, Lemos PA, Mill JG, Krieger JE, Pereira AC. MYLIP p.N342S polymorphism is not associated with lipid profile in the Brazilian population. Lipids Health Dis. 2012;11:83. doi: 10.1186/1476-511X-11-83.
    1. Santos PC, Alvim Rde O, Ferreira NE, de Sa CR, Krieger JE, Mill JG, Pereira AC. Ethnicity and arterial stiffness in Brazil. Am J Hypertens. 2011;24(3):278–284. doi: 10.1038/ajh.2010.244.
    1. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. Guidelines Subcommittee. J Hypertens. 1999;17(2):151–183.
    1. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S. et al.2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) J Hypertens. 2007;25(6):1105–1187. doi: 10.1097/HJH.0b013e3281fc975a.
    1. Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac AM, Target R, Levy BI. Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension. 1995;26(3):485–490. doi: 10.1161/01.HYP.26.3.485.
    1. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339(4):229–234. doi: 10.1056/NEJM199807233390404.
    1. Li CH, Wu JS, Yang YC, Shih CC, Lu FH, Chang CJ. Increased arterial stiffness in subjects with impaired glucose tolerance and newly diagnosed diabetes but not isolated impaired fasting glucose. J Clin Endocrinol Metab. 2012;97(4):E658–662. doi: 10.1210/jc.2011-2595.
    1. Galler A, Heitmann A, Siekmeyer W, Gelbrich G, Kapellen T, Kratzsch J, Kiess W. Increased arterial stiffness in children and adolescents with type 1 diabetes: no association between arterial stiffness and serum levels of adiponectin. Pediatr Diabetes. 2010;11(1):38–46. doi: 10.1111/j.1399-5448.2009.00525.x.
    1. Chen Y, Huang Y, Li X, Xu M, Bi Y, Zhang Y, Gu W, Ning G. Association of arterial stiffness with HbA1c in 1,000 type 2 diabetic patients with or without hypertension. Endocrine. 2009;36(2):262–267. doi: 10.1007/s12020-009-9221-z.
    1. Lukich E, Matas Z, Boaz M, Shargorodsky M. Increasing derangement of glucose homeostasis is associated with increased arterial stiffness in patients with diabetes, impaired fasting glucose and normal controls. Diabetes Metab Res Rev. 2010;26(5):365–370. doi: 10.1002/dmrr.1086.
    1. Vyssoulis G, Pietri P, Vlachopoulos C, Alexopoulos N, Kyvelou SM, Terentes-Printzios D, Stefanadis C. Early adverse effect of abnormal glucose metabolism on arterial stiffness in drug naive hypertensive patients. Diab Vasc Dis Res. 2012;9(1):18–24. doi: 10.1177/1479164111422827.
    1. Yue WS, Lau KK, Siu CW, Wang M, Yan GH, Yiu KH, Tse HF. Impact of glycemic control on circulating endothelial progenitor cells and arterial stiffness in patients with type 2 diabetes mellitus. Cardiovasc Diabetol. 2011;10:113. doi: 10.1186/1475-2840-10-113.
    1. Mazzone T, Chait A, Plutzky J. Cardiovascular disease risk in type 2 diabetes mellitus: insights from mechanistic studies. Lancet. 2008;371(9626):1800–1809. doi: 10.1016/S0140-6736(08)60768-0.
    1. Aronson D. Cross-linking of glycated collagen in the pathogenesis of arterial and myocardial stiffening of aging and diabetes. J Hypertens. 2003;21(1):3–12. doi: 10.1097/00004872-200301000-00002.
    1. McVeigh GE, Brennan GM, Johnston GD, McDermott BJ, McGrath LT, Henry WR, Andrews JW, Hayes JR. Impaired endothelium-dependent and independent vasodilation in patients with type 2 (non-insulin-dependent) diabetes mellitus. Diabetologia. 1992;35(8):771–776.
    1. Naka KK, Papathanassiou K, Bechlioulis A, Kazakos N, Pappas K, Tigas S, Makriyiannis D, Tsatsoulis A, Michalis LK. Determinants of vascular function in patients with type 2 diabetes. Cardiovasc Diabetol. 2012;11:127. doi: 10.1186/1475-2840-11-127.
    1. Tan KC, Chow WS, Ai VH, Metz C, Bucala R, Lam KS. Advanced glycation end products and endothelial dysfunction in type 2 diabetes. Diabetes Care. 2002;25(6):1055–1059. doi: 10.2337/diacare.25.6.1055.
    1. Watts GF, O’Brien SF, Silvester W, Millar JA. Impaired endothelium-dependent and independent dilatation of forearm resistance arteries in men with diet-treated non-insulin-dependent diabetes: role of dyslipidaemia. Clin Sci (Lond) 1996;91(5):567–573.
    1. Ferrannini E, Cushman WC. Diabetes and hypertension: the bad companions. Lancet. 2012;380(9841):601–610. doi: 10.1016/S0140-6736(12)60987-8.
    1. Chen G, McAlister FA, Walker RL, Hemmelgarn BR, Campbell NR. Cardiovascular outcomes in framingham participants with diabetes: the importance of blood pressure. Hypertension. 2011;57(5):891–897. doi: 10.1161/HYPERTENSIONAHA.110.162446.
    1. Cardoso CR, Ferreira MT, Leite NC, Barros PN, Conte PH, Salles GF. Microvascular degenerative complications are associated with increased aortic stiffness in type 2 diabetic patients. Atherosclerosis. 2009;205(2):472–476. doi: 10.1016/j.atherosclerosis.2008.12.027.
    1. Tedesco MA, Natale F, Di Salvo G, Caputo S, Capasso M, Calabro R. Effects of coexisting hypertension and type II diabetes mellitus on arterial stiffness. J Hum Hypertens. 2004;18(7):469–473. doi: 10.1038/sj.jhh.1001690.
    1. Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, Horan MJ, Labarthe D. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension. 1995;25(3):305–313. doi: 10.1161/01.HYP.25.3.305.
    1. Sytkowski PA, D’Agostino RB, Belanger AJ, Kannel WB. Secular trends in long-term sustained hypertension, long-term treatment, and cardiovascular mortality. The Framingham Heart Study 1950 to 1990. Circulation. 1996;93(4):697–703. doi: 10.1161/01.CIR.93.4.697.
    1. Ferreira AV, Viana MC, Mill JG, Asmar RG, Cunha RS. Racial differences in aortic stiffness in normotensive and hypertensive adults. J Hypertens. 1999;17(5):631–637. doi: 10.1097/00004872-199917050-00006.
    1. Burt VL, Cutler JA, Higgins M, Horan MJ, Labarthe D, Whelton P, Brown C, Roccella EJ. Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991. Hypertension. 1995;26(1):60–69. doi: 10.1161/01.HYP.26.1.60.
    1. Cornoni-Huntley J, LaCroix AZ, Havlik RJ. Race and sex differentials in the impact of hypertension in the United States. The National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Intern Med. 1989;149(4):780–788. doi: 10.1001/archinte.1989.00390040022005.
    1. Strain WD, Chaturvedi N, Dockery F, Shiff R, Shore AC, Bulpitt CJ, Rajkumar C. Increased arterial stiffness in Europeans and African Caribbeans with type 2 diabetes cannot be accounted for by conventional cardiovascular risk factors. Am J Hypertens. 2006;19(9):889–896. doi: 10.1016/j.amjhyper.2006.01.009.
    1. Van Bortel LM, Laurent S, Boutouyrie P, Chowienczyk P, Cruickshank JK, De Backer T, Filipovsky J, Huybrechts S, Mattace-Raso FU, Protogerou AD. et al.Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens. 2012;30(3):445–448. doi: 10.1097/HJH.0b013e32834fa8b0.

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