Diabetes and Vascular Research Group, Department of Cardiovascular Sciences, University of Leicester, Leicester LE1 5WW, UK.
Diabetologia. 2010 Jun;53(6):1190-8. doi: 10.1007/s00125-010-1689-9. Epub 2010 Mar 6.
AIMS/HYPOTHESIS: Non-invasive measures of aortic stiffness reflect vascular senescence and predict outcome in diabetes. Glucose-mediated elastic artery sclerosis may play an integral role in the development of macrovascular complications. We used carotid-femoral pulse wave velocity ((cf)PWV) to quantify independent associations of fasting glucose, post-challenge glucose and derived insulin resistance (HOMA-IR) with aortic stiffness.
(cf)PWV was measured using a 4 MHz continuous wave Doppler ultrasound probe within groups with newly identified age- and sex-matched normal glucose metabolism (NGM), impaired glucose regulation (IGR) and diabetes mellitus populations (n = 570, mean age 59.1, 56% male).
After multivariate adjustment, IGR and diabetes were associated with significant aortic stiffening compared with NGM (adjusted (cf)PWV+/-SE: NGM, 9.15 +/- 0.12 m/s; IGR 9.76 +/- 0.11 m/s, p < 0.001; diabetes, 9.89 +/- 0.12 m/s, p < 0.001). IGR stratification indicated that impaired fasting glucose (IFG; 9.71 +/- 0.12 m/s) and post-challenge (impaired glucose tolerance; 9.82 +/- 0.24 m/s) categories had similar (cf)PWV (p = 0.83). Modelled predictors of (cf)PWV were used to assess independent metabolic associations with arterial stiffness. Fasting glucose concentration (beta = 0.10; 95% CI 0.05, 0.18; p = 0.003), 2 h post-challenge glucose (beta = 0.14; 95% CI 0.02, 0.23; p < 0.001) and HOMA-IR (beta = 0.20, 95% CI 0.05, 0.53; p < 0.001) were independently related to (cf)PWV after adjustment for age, sex, mean arterial pressure, heart rate, body mass index, renal function and antihypertensive medication.
CONCLUSIONS/INTERPRETATION: IGR characterised by fasting or post-challenge hyperglycaemia is associated with significant vascular stiffening. Post-challenge glucose and HOMA-IR are the most powerful metabolic predictors of arterial stiffness, implying hyperglycaemic excursion and insulin resistance play important roles in the pathogenesis of arteriosclerosis.
目的/假设：非侵入性的主动脉僵硬测量反映血管衰老，并预测糖尿病的结果。葡萄糖介导的弹性动脉硬化可能在大血管并发症的发展中发挥重要作用。我们使用颈股脉搏波速度（（cf）PWV）来量化空腹血糖、餐后血糖和衍生胰岛素抵抗（HOMA-IR）与主动脉僵硬的独立关联。
在新确定的年龄和性别匹配的正常葡萄糖代谢（NGM）、葡萄糖调节受损（IGR）和糖尿病患者组（n=570，平均年龄 59.1，56%男性）中，使用 4 MHz 连续波多普勒超声探头测量（cf）PWV。
在多变量调整后，与 NGM 相比，IGR 和糖尿病与明显的主动脉僵硬相关（调整后的（cf）PWV+/-SE：NGM，9.15 +/- 0.12 m/s；IGR 9.76 +/- 0.11 m/s，p < 0.001；糖尿病，9.89 +/- 0.12 m/s，p < 0.001）。IGR 分层表明，空腹血糖受损（IFG；9.71 +/- 0.12 m/s）和餐后（糖耐量受损；9.82 +/- 0.24 m/s）类别具有相似的（cf）PWV（p=0.83）。（cf）PWV 的模型预测因子用于评估与动脉僵硬相关的独立代谢关联。空腹血糖浓度（β=0.10；95%CI 0.05，0.18；p=0.003）、2 小时餐后血糖（β=0.14；95%CI 0.02，0.23；p < 0.001）和 HOMA-IR（β=0.20，95%CI 0.05，0.53；p < 0.001）在调整年龄、性别、平均动脉压、心率、体重指数、肾功能和降压药物后与（cf）PWV 独立相关。
结论/解释：以空腹或餐后高血糖为特征的 IGR 与明显的血管僵硬有关。餐后血糖和 HOMA-IR 是动脉僵硬最强有力的代谢预测因子，这意味着高血糖波动和胰岛素抵抗在动脉硬化的发病机制中发挥重要作用。
