Stehouwer C D A, Henry R M A, Ferreira I
Department of Internal Medicine, University Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
Diabetologia. 2008 Apr;51(4):527-39. doi: 10.1007/s00125-007-0918-3. Epub 2008 Feb 1.
Increased arterial stiffness associated with diabetes and the metabolic syndrome may in part explain the increased cardiovascular disease risk observed in these conditions. Arterial stiffness can be estimated by quantifying pulse pressure but is better described by distensibility and compliance coefficients, pulse wave velocity and wave reflection. The most common non-invasive methodologies used to quantify these estimates of arterial stiffness (e.g. ultrasonography and applanation tonometry) are also described. We then review and summarise the current data on the associations between diabetes, the metabolic syndrome and insulin resistance on the one hand and greater arterial stiffness on the other, and identify and discuss some unresolved issues such as differential stiffening of central vs peripheral arterial segments, the impact of sex, and the pathobiology of increased arterial stiffness in diabetes and the metabolic syndrome. Finally, some considerations with regard to treatment options are presented. At present the most powerful therapy available for reducing arterial stiffness is to vigorously treat hypertension using pharmacological agents. New pharmacological strategies to reduce arterial stiffness are likely to be especially relevant to individuals with diabetes.
与糖尿病和代谢综合征相关的动脉僵硬度增加，可能部分解释了在这些情况下观察到的心血管疾病风险增加。动脉僵硬度可以通过量化脉压来估计，但用扩张性和顺应性系数、脉搏波速度和波反射来描述会更好。还介绍了用于量化这些动脉僵硬度估计值的最常见非侵入性方法（如超声检查和平板测压法）。然后，我们回顾并总结了目前关于糖尿病、代谢综合征和胰岛素抵抗与更高动脉僵硬度之间关联的数据，并识别和讨论了一些未解决的问题，如中心动脉段与外周动脉段的差异硬化、性别影响以及糖尿病和代谢综合征中动脉僵硬度增加的病理生物学。最后，提出了一些关于治疗选择的考虑因素。目前，可用于降低动脉僵硬度的最有效疗法是使用药物积极治疗高血压。降低动脉僵硬度的新药理学策略可能对糖尿病患者尤其重要。
