Department of Medicine and Bioregulatory Sciences, The University of Tokushima, Graduate School of Health Biosciences.
J Atheroscler Thromb. 2014;21(5):486-500. doi: 10.5551/jat.20834. Epub 2014 Jan 8.
The levels of fasting and postprandial plasma glucose, HbA1c and other risk factors for atherosclerosis have distinct effects in patients with and those without diabetes mellitus. The aim of this study was to determine the impact of diabetic surrogate markers on the endothelial function, arterial stiffness and carotid atherosclerosis in individuals with and without diabetes.
A total of 320 Japanese subjects(mean age: 61.2 ± 12.1 years) were recruited in this study. Demographic, clinical and laboratory parameters, including 75 g OGTT(155 subjects) results, were examined. The endothelial function was evaluated according to the flow-mediated vasodilation of the brachial artery(%FMD). In addition, arterial stiffness was evaluated according to the brachial-ankle pulse wave velocity(baPWV), and carotid atherosclerotic changes were estimated according to the maximum intima-media thickness(max-IMT) and resistive index of the common carotid artery(CCA-RI). A multiple regression analysis was performed to identify independent determinants of these vascular surrogate markers.
None of the glucose-related parameters were associated with the %FMD. In contrast, the presence of T2DM, the HbA1c level and an increased plasma glucose level at 60 minutes during 75 g OGTT were associated with an increased baPWV. The HbA1c level was also correlated with an increased max-IMT. The fasting plasma glucose(FPG) level and the presence of T2DM correlated with an increased CCA-RI. In the subjects with T2DM, the protective effects of high-density lipoprotein cholesterol(HDL-C) on the %FMD and baPWV were abolished.
Various glucose metabolism parameters have different effects the degree of arterial stiffness and presence of carotid atherosclerosis, but not the endothelial function, suggesting that pharmacological intervention has the potential to preserve the endothelial function in diabetic individuals. In addition, the presence of T2DM blunts the vascular protective effects of HDL-C on the endothelial function and progression of arterial stiffness.
空腹和餐后血糖、糖化血红蛋白（HbA1c）和其他动脉粥样硬化风险因素在糖尿病患者和非糖尿病患者中的作用不同。本研究旨在确定糖尿病替代标志物对糖尿病和非糖尿病个体内皮功能、动脉僵硬度和颈动脉粥样硬化的影响。
本研究共纳入 320 名日本受试者（平均年龄：61.2±12.1 岁）。检查了人口统计学、临床和实验室参数，包括 75g 口服葡萄糖耐量试验（OGTT）（155 名受试者）结果。根据肱动脉血流介导的血管扩张（%FMD）评估内皮功能。此外，根据肱踝脉搏波速度（baPWV）评估动脉僵硬度，根据颈总动脉最大内膜中层厚度（max-IMT）和阻力指数（CCA-RI）评估颈动脉粥样硬化变化。进行多元回归分析以确定这些血管替代标志物的独立决定因素。
血糖相关参数均与 %FMD 无关。相反，T2DM 的存在、HbA1c 水平和 75g OGTT 后 60 分钟时升高的血糖水平与 baPWV 升高相关。HbA1c 水平也与 max-IMT 增加相关。空腹血糖（FPG）水平和 T2DM 的存在与 CCA-RI 增加相关。在 T2DM 患者中，高密度脂蛋白胆固醇（HDL-C）对 %FMD 和 baPWV 的保护作用被消除。
各种血糖代谢参数对动脉僵硬度和颈动脉粥样硬化的程度有不同的影响，但对内皮功能没有影响，这表明药物干预有可能在糖尿病患者中保留内皮功能。此外，T2DM 的存在削弱了 HDL-C 对内皮功能和动脉僵硬度进展的血管保护作用。
