Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
Diabetes Centre, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore; Department of Medicine, Khoo Teck Puat Hospital, Singapore 768828, Republic of Singapore.
Atherosclerosis. 2014 Oct;236(2):286-91. doi: 10.1016/j.atherosclerosis.2014.07.017. Epub 2014 Jul 27.
Type 2 diabetes (T2DM) among the young population has become a serious concern globally, presumably due to the rising trend of obesity. Compared to other forms of diabetes, young-onset T2DM experiences more cardiovascular events and other vascular complications although the underlying mechanisms remain largely unknown. Increased arterial stiffness is a hallmark of vasculopathy. We aim to study the clinical and metabolic determinants of arterial stiffness in a cohort of multi-ethnic Asians with young-onset T2DM.
179 subjects with T2DM onset age below 30 years old were selected in this cross sectional study. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV).
PWV was correlated with age, duration of diabetes, systolic blood pressure, alanine aminotransferase, urinary albumin-to-creatinine ratio (ACR) and eGFR in bivariate correlation analysis. However, PWV was only significantly correlated with body mass index (BMI), waist circumference, urinary ACR and eGFR after adjustment for age. Overweight individuals with young-onset T2DM had significantly higher PWV levels compared to their lean counterparts (7.3 ± 2.4 m/s vs 6.4 ± 2.3 m/s, p = 0.072 and p < 0.0001 without and with adjustment for age, respectively). Multivariable regression models revealed that age, BMI, eGFR and usage of insulin were independently associated with PWV. These 4 variables explained 35.5% variance in PWV levels.
Age, BMI, renal function and insulin usage are the main determinants of PWV levels in Asians with young-onset T2DM. Notably, obesity is a modifiable determinant of arterial stiffness independent of high blood pressure, dyslipidemia and hyperglycemia in this population.
全球范围内，年轻人罹患 2 型糖尿病（T2DM）已成为一个严重的问题，推测这与肥胖率的上升趋势有关。与其他类型的糖尿病相比，青年起病的 2 型糖尿病发生更多心血管事件和其他血管并发症，尽管其潜在机制在很大程度上仍不清楚。动脉僵硬度增加是血管病变的一个标志。我们旨在研究一个多民族亚洲青年起病 2 型糖尿病患者队列中动脉僵硬度的临床和代谢决定因素。
本横断面研究纳入了 179 名发病年龄<30 岁的 T2DM 患者。通过颈股脉搏波速度（PWV）评估动脉僵硬度。
在双变量相关分析中，PWV 与年龄、糖尿病病程、收缩压、丙氨酸氨基转移酶、尿白蛋白/肌酐比值（ACR）和 eGFR 相关。然而，在调整年龄后，PWV 仅与体重指数（BMI）、腰围、尿 ACR 和 eGFR 显著相关。与消瘦者相比，超重的青年起病 2 型糖尿病患者的 PWV 水平显著升高（7.3±2.4 m/s 比 6.4±2.3 m/s，p=0.072 和 p<0.0001，未调整和调整年龄后）。多变量回归模型显示，年龄、BMI、eGFR 和胰岛素使用与 PWV 独立相关。这 4 个变量解释了 PWV 水平 35.5%的方差。
年龄、BMI、肾功能和胰岛素使用是亚洲青年起病 2 型糖尿病患者 PWV 水平的主要决定因素。值得注意的是，在该人群中，肥胖是动脉僵硬度的一个可改变的决定因素，独立于高血压、血脂异常和高血糖。
