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Jahn LA, Hartline LM, Kleiner AJ, Horton WB, Hasan F, Wai Kit Tan A, Liu Z, Barrett EJ. Insulin-induced vasoconstriction is prevalent in muscle microvasculature of otherwise healthy persons with type 1 diabetes. Am J Physiol Endocrinol Metab 2023; 324:E402-E408. [PMID: 36920998 PMCID: PMC10125023 DOI: 10.1152/ajpendo.00242.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/09/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
Insulin's microvascular actions and their relationship to insulin's metabolic actions have not been well studied in adults with type 1 diabetes mellitus (T1DM). We compared the metabolic and selected micro- and macrovascular responses to insulin by healthy adult control (n = 16) and subjects with T1DM (n = 15) without clinical microvascular disease. We measured insulin's effect on 1) skeletal muscle microvascular perfusion using contrast-enhanced ultrasound (CEU), 2) arterial stiffness using carotid-femoral pulse-wave velocity (cfPWV) and radial artery pulse wave analysis (PWA), and 3) metabolic insulin sensitivity by the glucose infusion rate (GIR) during a 2-h, 1 mU/min/kg euglycemic-insulin clamp. Subjects with T1DM were metabolically insulin resistant (GIR = 5.2 ± 0.7 vs. 6.6 ± 0.6 mg/min/kg, P < 0.001). Insulin increased muscle microvascular blood volume and flow in control (P < 0.001, for each) but not in subjects with T1DM. Metabolic insulin sensitivity correlated with increases of muscle microvascular perfused volume (P < 0.05). Baseline measures of vascular stiffness did not differ between groups. However, during hyperinsulinemia, cfPWV was greater (P < 0.02) in the T1DM group and the backward pulse wave pressure declined with insulin only in controls (P < 0.03), both indices indicating that insulin-induced vascular relaxation in controls only. Subjects with T1DM have muscle microvascular insulin resistance that may precede clinical microvascular disease.NEW & NOTEWORTHY Using contrast ultrasound and measures of vascular stiffness, we compared vascular and metabolic responses to insulin in patients with type 1 diabetes with age-matched controls. The patients with type 1 diabetes demonstrated both vascular and metabolic insulin resistance with more than half of the patients with diabetes having a paradoxical vasoconstrictive vascular response to insulin.
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Affiliation(s)
- Linda A Jahn
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States
| | - Lee M Hartline
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States
| | - Amanda J Kleiner
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States
| | - William B Horton
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States
| | - Farhad Hasan
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States
| | - Alvin Wai Kit Tan
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States
| | - Zhenqi Liu
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States
| | - Eugene J Barrett
- Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia, United States
- Department of Pharmacology, University of Virginia, School of Medicine, Charlottesville, Virginia, United States
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Jahn LA, Logan B, Love KM, Horton WB, Eichner NZ, Hartline LM, Weltman AL, Barrett EJ. Nitric oxide-dependent micro- and macrovascular dysfunction occurs early in adolescents with type 1 diabetes. Am J Physiol Endocrinol Metab 2022; 322:E101-E108. [PMID: 34894721 PMCID: PMC8799398 DOI: 10.1152/ajpendo.00267.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/16/2021] [Accepted: 12/05/2021] [Indexed: 11/22/2022]
Abstract
Arterial stiffness and endothelial dysfunction are both reported in children with type 1 diabetes (DM1) and may predict future cardiovascular events. In health, nitric oxide (NO) relaxes arteries and increases microvascular perfusion. The relationships between NO-dependent macro- and microvascular functional responses and arterial stiffness have not been studied in adolescents with DM1. Here, we assessed macro- and microvascular function in DM1 adolescents and age-matched controls at baseline and during an oral glucose challenge (OGTT). DM1 adolescents (n = 16) and controls (n = 14) were studied before and during an OGTT. At baseline, we measured: 1) large artery stiffness using both aortic augmentation index (AI) and carotid-femoral pulse wave velocity (cfPWV); 2) brachial flow-mediated dilation (FMD) and forearm endothelial function using postischemic flow velocity (PIFV); and 3) forearm muscle microvascular blood volume (MBV) using contrast-enhanced ultrasound. Following OGTT, AI, cfPWV, and MBV were reassessed at 60 min and MBV again at 120 min. Within individual and between-group, comparisons were made by paired and unpaired t tests or repeated measures ANOVA. Baseline FMD was lower (P = 0.02) in DM1. PWV at 0 and 60 min did not differ between groups. Baseline AI did not differ between groups but declined with OGTT only in controls (P = 0.02) and was lower than DM1 at 60 min (P < 0.03). Baseline MBV was comparable in DM1 and control groups, but declined in DM1 at 120 min (P = 0.01) and was lower than the control group (P < 0.03). There was an inverse correlation between plasma glucose and MBV at 120 min (r = -0.523, P < 0.01). No differences were noted between groups for V̇O2max (mL/min/kg), body fat (%), or body mass index (BMI). NO-dependent macro- and microvascular function, including FMD and AI, and microvascular perfusion, respectively, are impaired early in the course of DM1, precede increases of arterial stiffness, and may provide an early indicator of vascular risk.NEW & NOTEWORTHY This is the first study to show that type 1 diabetes impairs multiple nitric oxide-dependent vascular functions.
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Affiliation(s)
- Linda A Jahn
- Department of Medicine, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
| | - Brent Logan
- Department of Pediatrics, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
| | - Kaitlin M Love
- Department of Medicine, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
| | - William B Horton
- Department of Medicine, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
| | - Natalie Z Eichner
- Department of Kinesiology, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
| | - Lee M Hartline
- Department of Medicine, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
| | - Arthur L Weltman
- Department of Medicine, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
- Department of Kinesiology, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
| | - Eugene J Barrett
- Department of Medicine, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
- Department of Pediatrics, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
- Department of Pharmacology, School of Medicine, College of Arts and Sciences, University of Virginia, Charlottesville, Virginia
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Love KM, Horton WB, Patrie JT, Jahn LA, Hartline LM, Barrett EJ. Predictors of arterial stiffness in adolescents and adults with type 1 diabetes: a cross-sectional study. BMJ Open Diabetes Res Care 2022; 10:e002491. [PMID: 34987053 PMCID: PMC8734015 DOI: 10.1136/bmjdrc-2021-002491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Individuals with type 1 diabetes have increased arterial stiffness compared with age-matched healthy controls. Our aim was to determine which hemodynamic and demographic factors predict arterial stiffness in this population. RESEARCH DESIGN AND METHODS Carotid-femoral pulse wave velocity (cfPWV) was examined in 41 young adults and adolescents with type 1 diabetes without microvascular complications. Two ordinary least squares regression analyses were performed to determine multivariate relationships between cfPWV (loge) and (1) age, duration of diabetes, sex, and hemoglobin A1c and (2) augmentation index (AIx), mean arterial pressure, flow-mediated dilation (FMD), and heart rate. We also examined differences in macrovascular outcome measures between sexes. RESULTS Age, sex, and FMD provided unique predictive information about cfPWV in these participants with type 1 diabetes. Despite having similar cardiovascular risk factors, men had higher cfPWV compared with women but no differences were observed in other macrovascular outcomes (including FMD and AIx). CONCLUSIONS Only age, sex, and FMD were uniquely associated with arterial stiffness in adolescents and adults with uncomplicated type 1 diabetes. Women had less arterial stiffness and similar nitric oxide-dependent endothelial function compared with men. Larger, prospective investigation is warranted to determine the temporal order of and sex differences in arterial dysfunction in type 1 diabetes.
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Affiliation(s)
- Kaitlin M Love
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - William B Horton
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Linda A Jahn
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Lee M Hartline
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eugene J Barrett
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Pharmacology, University of Virginia Health System, Charlottesville, Virginia, USA
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Llauradó G, Amigó N, Cano A, Ballesta S, Albert L, Mazarico I, Fernández-Veledo S, Pedro-Botet J, Vendrell J, González-Clemente JM. Specific Nuclear Magnetic Resonance Lipoprotein Subclass Profiles and Central Arterial Stiffness in Type 1 Diabetes Mellitus: A Case Control Study. J Clin Med 2019; 8:E1875. [PMID: 31694246 PMCID: PMC6912486 DOI: 10.3390/jcm8111875] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Dyslipidemia has been associated with vascular complications of type 1 diabetes mellitus (T1DM). We examined the proton nuclear magnetic resonance (NMR)-assessed lipoprotein subclass profiles in subjects with T1DM compared with those of healthy subjects and assessed the potential relationship of these profiles with arterial stiffness. METHODS Eighty-four participants with T1DM of at least 10 years duration and no clinical cardiovascular disease (age: 35-65 years; 50% men) and 42 healthy participants were evaluated for: (1) clinical and anthropometric data (including classical cardiovascular risk factors), (2) insulin sensitivity by estimated glucose disposal rate, (3) microvascular complications, (4) NMR-assessed lipoprotein subclass profile, and (5) arterial stiffness (aortic pulse wave velocity). RESULTS Participants with T1DM had an apparently better conventional lipid profile than healthy participants, but with significant differences in NMR-assessed lipoprotein profiles such as higher triglyceride content of low-density lipoprotein (LDL) and high-density lipoprotein (HDL). In healthy participants, arterial stiffness was associated with NMR-based LDL subclasses. By contrast, in T1DM participants, arterial stiffness was independently associated mainly with NMR-based very-low-density lipoprotein (VLDL) subclasses: positively with total VLDL particles (and subclasses) and VLDL triglyceride content, and negatively with LDL and HDL particle sizes. These results were maintained after adjustments for classical cardiovascular risk factors. CONCLUSIONS Subjects with T1DM, while having an apparently better conventional lipid profile than healthy controls, presented significant alterations in their NMR-assessed lipoprotein profile. The association between arterial stiffness and NMR-assessed lipoprotein profiles also differed in both groups. These results support a potential role of the identified differences in the residual cardiovascular risk in T1DM.
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Affiliation(s)
- Gemma Llauradó
- Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Pg. Marítim 25-29, 08003 Barcelona, Spain; (S.B.); (J.P.-B.)
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas; (CIBERDEM), Instituto de Salud Carlos III, 8029 Madrid, Spain; (S.F.-V.); (J.V.)
| | - Núria Amigó
- Metabolomics Platform IISPV, CIBERDEM. Universitat Rovira i Virgili, Bisofer Teslab Plaça del Prim 10, 43201 Reus, Spain;
| | - Albert Cano
- Department of Endocrinology and Nutrition. Hospital de Sabadell. Corporació Sanitària Parc Taulí. Institut d’Investigació i Innovació Parc Taulí (I3PT) (Universitat Autònoma de Barcelona), Parc Taulí s/n, 08208 Sabadell, Spain; (A.C.); (L.A.); (I.M.)
| | - Silvia Ballesta
- Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Pg. Marítim 25-29, 08003 Barcelona, Spain; (S.B.); (J.P.-B.)
| | - Lara Albert
- Department of Endocrinology and Nutrition. Hospital de Sabadell. Corporació Sanitària Parc Taulí. Institut d’Investigació i Innovació Parc Taulí (I3PT) (Universitat Autònoma de Barcelona), Parc Taulí s/n, 08208 Sabadell, Spain; (A.C.); (L.A.); (I.M.)
| | - Isabel Mazarico
- Department of Endocrinology and Nutrition. Hospital de Sabadell. Corporació Sanitària Parc Taulí. Institut d’Investigació i Innovació Parc Taulí (I3PT) (Universitat Autònoma de Barcelona), Parc Taulí s/n, 08208 Sabadell, Spain; (A.C.); (L.A.); (I.M.)
| | - Sonia Fernández-Veledo
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas; (CIBERDEM), Instituto de Salud Carlos III, 8029 Madrid, Spain; (S.F.-V.); (J.V.)
- Hospital Universitari Joan XXIII de Tarragona. Institut d’Investigacions Sanitàries Pere Virgili (IISPV). Universitat Rovira i Virgili, C. Dr. Mallafré Guasch 4, 43005 Tarragona, Spain
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Pg. Marítim 25-29, 08003 Barcelona, Spain; (S.B.); (J.P.-B.)
| | - Joan Vendrell
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas; (CIBERDEM), Instituto de Salud Carlos III, 8029 Madrid, Spain; (S.F.-V.); (J.V.)
- Hospital Universitari Joan XXIII de Tarragona. Institut d’Investigacions Sanitàries Pere Virgili (IISPV). Universitat Rovira i Virgili, C. Dr. Mallafré Guasch 4, 43005 Tarragona, Spain
| | - José-Miguel González-Clemente
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas; (CIBERDEM), Instituto de Salud Carlos III, 8029 Madrid, Spain; (S.F.-V.); (J.V.)
- Department of Endocrinology and Nutrition. Hospital de Sabadell. Corporació Sanitària Parc Taulí. Institut d’Investigació i Innovació Parc Taulí (I3PT) (Universitat Autònoma de Barcelona), Parc Taulí s/n, 08208 Sabadell, Spain; (A.C.); (L.A.); (I.M.)
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Sveen KA, Dahl-Jørgensen K, Stensaeth KH, Angel K, Seljeflot I, Sell DR, Monnier VM, Hanssen KF. Glucosepane and oxidative markers in skin collagen correlate with intima media thickness and arterial stiffness in long-term type 1 diabetes. J Diabetes Complications 2015; 29:407-12. [PMID: 25600701 DOI: 10.1016/j.jdiacomp.2014.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/20/2014] [Accepted: 12/20/2014] [Indexed: 01/21/2023]
Abstract
AIMS To study intima media thickness (cIMT) and arterial stiffness in type 1 diabetes of long duration, and their associations with the collagen cross-linker glucosepane and inflammatory and oxidative markers. METHODS Twenty-seven individuals with type 1 diabetes mellitus of 40 years duration from the Oslo Study cohort and 24 age-matched controls were included. cIMT measurements of the carotid artery were performed longitudinally. Pulse wave velocity (PWV), augmentation index (AIx) and augmentation pressure (AP) were assessed cross-sectionally. Glucosepane and the oxidative product methionine sulfoxide (MetSO) were determined in skin collagen by liquid chromatography-mass spectrometry. Circulating inflammatory markers were determined by ELISAs. RESULTS The diabetes patients had significantly increased cIMT and arterial stiffness compared to controls. Significant correlations were noted for skin glucosepane with cIMT (r=0.41) and PWV (r=0.44). Skin MetSO and monocyte chemoattractant protein-1 (MCP-1) correlated significantly with AIx and AP. After correcting for age and mean arterial pressure in multiple linear regression analysis, MetSO and MCP-1 were both independently associated with AIx and AP. CONCLUSIONS These results suggest more premature atherosclerosis and arterial pathology in individuals with diabetes compared to age-matched controls. They also suggest an association between the arterial pathology and markers of collagen crosslinking, oxidative damage and inflammation in type 1 diabetes patients of forty years disease duration.
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Affiliation(s)
- Kari Anne Sveen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine University of Oslo, Oslo, Norway.
| | - Knut Dahl-Jørgensen
- Department of Pediatrics, Oslo University Hospital, Ullevaal, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine University of Oslo, Oslo, Norway
| | - Knut Haakon Stensaeth
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Kristin Angel
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ingebjørg Seljeflot
- Department of Cardiology, Oslo University Hospital, Oslo, Norway; Center for Clinical Heart Research, Oslo University hospital, Ullevaal, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine University of Oslo, Oslo, Norway
| | - David R Sell
- Departments of Pathology and Biochemistry Case Western Reserve University, Cleveland, OH, USA
| | - Vincent M Monnier
- Departments of Pathology and Biochemistry Case Western Reserve University, Cleveland, OH, USA
| | - Kristian F Hanssen
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine University of Oslo, Oslo, Norway
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Theilade S, Lajer M, Hansen TW, Rossing P. Pulse wave reflection is associated with diabetes duration, albuminuria and cardiovascular disease in type 1 diabetes. Acta Diabetol 2014; 51:973-80. [PMID: 25274394 DOI: 10.1007/s00592-014-0651-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/08/2014] [Indexed: 10/24/2022]
Abstract
AIMS We investigate associations between the pulse-wave-derived measures augmentation pressure (AP) and augmentation index, and diabetic complications in type 1 diabetes. METHODS This cross-sectional study from 2009-2011 included 676 type 1 diabetes patients. SphygmoCor (Atcor Medical, Australia) measured AP and heart rate-adjusted augmentation index (AI75). Diabetic complications were micro- or macroalbuminuria [urinary albumin excretion rate (UAER) 30-299 or ≥300 mg/24-h], cardiovascular disease (CVD) (previous revascularization, myocardial infarction, peripheral arterial disease or stroke), autonomic dysfunction (heart rate variability <11 beats/min), or retinopathy (simple, proliferative or blindness). Adjustments included age, gender, diabetes duration, mean arterial pressure, heart rate, height, UAER, eGFR, HbA1c, total cholesterol, total daily insulin dose, antihypertensive medication, and smoking. RESULTS AP and AI75 measurements were available in 636 (94.1 %) patients and were 9.9 ± 7.6 mmHg and 16.9 ± 12.0, respectively. After adjustment, AP and AI75 were independently associated with diabetes duration and albuminuria (p ≤ 0.001). Furthermore, higher AP and AI75 were associated with previous CVD [adjusted odds ratios (95 % confidence interval) (per 1 SD increase) 1.9 (1.3-2.7) and 1.5 (1.0-2.2) (p ≤ 0.039)], but not with autonomic dysfunction or retinopathy (p ≥ 0.12). CONCLUSIONS In type 1 diabetes, augmentation pressure and heart rate-adjusted augmentation index were associated with diabetes duration, albuminuria, and CVD, independently of conventional risk factors. ClinicalTrials.gov:NCT01171248.
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Affiliation(s)
- Simone Theilade
- Steno Diabetes Center, Niels Steensens Vej 1, 2820, Gentofte, Denmark,
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Konduracka E, Cieslik G, Galicka-Latala D, Rostoff P, Pietrucha A, Latacz P, Gajos G, Malecki MT, Nessler J. Myocardial dysfunction and chronic heart failure in patients with long-lasting type 1 diabetes: a 7-year prospective cohort study. Acta Diabetol 2013; 50:597-606. [PMID: 23358920 PMCID: PMC3778905 DOI: 10.1007/s00592-013-0455-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 01/20/2013] [Indexed: 12/17/2022]
Abstract
The aim of the study is to evaluate the prevalence and incidence of myocardial dysfunction (MD) and heart failure (HF) in long-lasting (≥10 years) type 1 diabetes without cardiovascular disorders or with hypertension or coronary heart disease (CHD). The study included 1,685 patients with type 1 diabetes (mean baseline age, 51 years; diabetes duration, 36 years). In all patients, echocardiography was performed, NT-proBNP levels were measured, and clinical symptoms were evaluated. A 7-year follow-up was conducted to monitor systolic and diastolic manifestations of MD and HF. At the end of the follow-up period, the prevalence of HF in the entire group was 3.7 %, and the incidence was 0.02 % per year. The prevalence of MD was 14.5 % and the incidence -0.1 % per year. MD and HF were observed only in hypertensive or CHD patients. At baseline, subjects with diastolic HF constituted 85 % of the HF population and those with systolic HF the remaining 15 %. Baseline HF predictors included age, diabetes duration, HbA1c levels, CHD, systolic blood pressure >140 mmHg, and GFR <60 mL/min/1.73 m(2). In patients with type 1 diabetes, MD and HF occurred only when diabetes coexisted with cardiovascular disorders affecting myocardial function. The prevalence and incidence of HF in patients with hypertension and CHD were relatively low. While the cause of this observation remains uncertain, it could probably be explained, at least partially, by the cardioprotective effect of concomitant treatment.
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Affiliation(s)
- Ewa Konduracka
- Department of Coronary Disease, Jagiellonian University School of Medicine, John Paul II Hospital, Prądnicka 80, 31-202, Krakow, Poland,
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