Henry Ronald M A, Kamp Otto, Kostense Piet J, Spijkerman Annemieke M W, Dekker Jacqueline M, van Eijck Rosemarie, Nijpels Giel, Heine Robert J, Bouter Lex M, Stehouwer Coen D A
Institute for Research in Extramural Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Diabetes Care. 2004 Feb;27(2):522-9. doi: 10.2337/diacare.27.2.522.
Type 2 diabetes and impaired glucose metabolism (IGM) are associated with an increased cardiovascular disease (CVD) risk. Increased left ventricular mass (LVM) is thought to increase CVD risk through several unfavorable cardiac changes. Type 2 diabetes and IGM are associated with increased LVM, but the underlying mechanism is unclear. We investigated the association between glucose tolerance status (GTS) and LVM and explored whether any such association could be mediated through increased arterial stiffness, impaired endothelial function, or the presence of atherosclerosis.
We used ultrasound to measure LVM, carotid and femoral stiffness, carotid-femoral transit time, and flow-mediated vasodilation (FMD) and tonometry to estimate compliance and augmentation index. The study population (n = 780) consisted of 287 individuals with normal glucose metabolism (NGM), 179 with IGM, and 314 with type 2 diabetes, and the mean age was 68.4 years.
In women, after adjusting for age, height, BMI, and mean arterial pressure, LVM increased significantly with deteriorating GTS (LVM 157 g in NGM, 155 g in IGM, and 169 g in type 2 diabetes; P for trend <0.018). Additional adjustment for arterial stiffness, FMD, or the presence of atherosclerosis did not materially alter the results, even though these variables were significantly associated with both GTS and LVM. Indexes of hyperglycemia/-insulinemia or insulin resistance explained at most 7% of the association between GTS and LVM. In men, no statistically significant associations were observed.
Our data expand the conceptual view of the pathogenesis of GTS-related changes in LVM because we show that the increase in LVM in women is independent of increased arterial stiffness, impaired FMD, or the presence of atherosclerosis. In addition, we show that this increase in LVM is only minimally explained by indexes of hyperglycemia/-insulinemia or insulin resistance. Our data may, in part, explain the increased CVD risk seen in women with deteriorating GTS.
2型糖尿病和糖代谢受损（IGM）与心血管疾病（CVD）风险增加相关。左心室质量（LVM）增加被认为通过多种不利的心脏变化增加CVD风险。2型糖尿病和IGM与LVM增加有关，但其潜在机制尚不清楚。我们研究了糖耐量状态（GTS）与LVM之间的关联，并探讨了这种关联是否可通过动脉僵硬度增加、内皮功能受损或动脉粥样硬化的存在来介导。
我们使用超声测量LVM、颈动脉和股动脉僵硬度、颈动脉-股动脉传输时间以及血流介导的血管舒张（FMD），并使用眼压测量法估计顺应性和增强指数。研究人群（n = 780）包括287例糖代谢正常（NGM）个体、179例IGM个体和314例2型糖尿病个体，平均年龄为68.4岁。
在女性中，调整年龄、身高、体重指数和平均动脉压后，LVM随GTS恶化而显著增加（NGM组LVM为157 g，IGM组为155 g，2型糖尿病组为169 g；趋势P<0.018）。即使这些变量与GTS和LVM均显著相关，但对动脉僵硬度、FMD或动脉粥样硬化的存在进行额外调整并未实质性改变结果。高血糖/高胰岛素血症或胰岛素抵抗指数最多解释了GTS与LVM之间关联的7%。在男性中，未观察到统计学上的显著关联。
我们的数据扩展了对GTS相关LVM变化发病机制的概念性认识，因为我们表明女性LVM的增加独立于动脉僵硬度增加、FMD受损或动脉粥样硬化的存在。此外，我们表明LVM的这种增加仅由高血糖/高胰岛素血症或胰岛素抵抗指数得到最小程度的解释。我们的数据可能部分解释了GTS恶化的女性中CVD风险增加的现象。
