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Lempesis IG, Varrias D, Sagris M, Attaran RR, Altin ES, Bakoyiannis C, Palaiodimos L, Dalamaga M, Kokkinidis DG. Obesity and Peripheral Artery Disease: Current Evidence and Controversies. Curr Obes Rep 2023; 12:264-279. [PMID: 37243875 PMCID: PMC10220347 DOI: 10.1007/s13679-023-00510-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 05/29/2023]
Abstract
PURPOSE OF REVIEW Obesity is a significant public health problem and a major risk factor for the development and progression of atherosclerosis and its cardiovascular manifestations. Lower extremity peripheral artery disease (PAD) affects 3%-10% of the Western population and, if left untreated, can lead to devastating outcomes with both an increased risk of morbidity and mortality. Interestingly, the association between obesity and PAD remains debatable. Whereas it is well known that PAD and obesity frequently overlap in the same patients, many studies have demonstrated a negative association between obesity and PAD and a protective effect of obesity on disease development and progression, a phenomenon described as the "obesity paradox." Possible mechanisms for this paradox may include genetic background, as assessed by mendelian randomization studies, adipose tissue dysfunction, and body fat distribution rather than adiposity, while other factors, such as sex, ethnicity, sarcopenia in the elderly population, or aggressive treatment of co-existing metabolic conditions in individuals with obesity compared to those with normal weight, could have some impact as well. RECENT RINDINGS Few reviews and meta-analyses examining systematically the relationship between obesity and PAD exist. The impact of PAD development due to the presence of obesity remains largely controversial. However, the most current evidence, backed by a recent meta-analysis, suggests a potential protective role of a higher body mass index on PAD-related complications and mortality. In this review, we discuss the association between obesity and PAD development, progression, and management, and the potential pathophysiologic mechanisms linking the two diseases.
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Affiliation(s)
- Ioannis G Lempesis
- Department of Biologic Chemistry, School of Medicine, National and Kapodistrian, University of Athens, Mikras Asias 75, 115 27, Athens, Greece.
| | - Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marios Sagris
- General Hospital of Nikaia, Piraeus, 184 54, Athens, Greece
| | - Robert R Attaran
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, 06519, New Haven, CT, USA
| | - Elissa S Altin
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, 06519, New Haven, CT, USA
| | - Christos Bakoyiannis
- Department of Surgery, Division of Vascular Surgery, Laikon General Hospital, National Kapodistrian University of Athens, 15772, Athens, Greece
| | - Leonidas Palaiodimos
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maria Dalamaga
- Department of Biologic Chemistry, School of Medicine, National and Kapodistrian, University of Athens, Mikras Asias 75, 115 27, Athens, Greece
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University/Yale New Haven Hospital, 06519, New Haven, CT, USA
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Lawal Y, Mshelia-Reng R, Omonua SO, Odumodu K, Shuaibu R, Itanyi UD, Abubakar AI, Kolade-Yunusa HO, Songden ZD, Ehusani CO, Adediran O, Anumah FE. Comparison of waist-height ratio and other obesity indices in the prediction of diabetic peripheral neuropathy. Front Nutr 2022; 9:949315. [PMID: 36276814 PMCID: PMC9582519 DOI: 10.3389/fnut.2022.949315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Waist-height ratio (WHtR) is increasingly being studied as a simple and effective measure of central obesity. Reports have shown that WHtR is a better predictor of hypertension, diabetes, and cardiovascular diseases when compared to traditional obesity indices like body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR). This study is therefore aimed at comparing WHtR with other obesity indices in the prediction of peripheral neuropathy in persons with diabetes mellitus (DM). Methodology One thousand and forty persons with DM were enrolled following consent. Relevant details of history were obtained, followed by physical examinations. Data were analyzed using IBM-SPSS version 23. Logistic regression was used to compare the odds ratio of obesity indices in the prediction of peripheral neuropathy. The level of significance used was p = 0.05. Results Logistic regression showed that WHtR had the highest odds ratio (OR) for the prediction of "probable" diabetic peripheral neuropathy (OR 9.11, 95% CI 3.07-47.97, p = 0.002), followed by WC (OR 2.01, 95% CI 1.09-4.05, p = 0.004), and BMI (OR 1.26, 95% CI 1.00-3.99, p = 0.019) after correction for age; systemic hypertension; duration of DM; control of SBP, DBP, HbA1c, FPG, and 2HrPP. Conclusion WHtR has the highest odds ratio in the prediction of "probable" diabetic peripheral neuropathy in both genders, followed by WC in the males and BMI in the females.
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Disparity in association of obesity measures with ankle and brachial systolic blood pressures in Europeans and South Asians. Sci Rep 2022; 12:9174. [PMID: 35655080 PMCID: PMC9163110 DOI: 10.1038/s41598-022-13372-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
Obesity causes increases in brachial systolic-blood-pressures (SBP), risks of type 2 diabetes (T2DM) and cardiovascular diseases (CVD). Brachial and ankle SBPs have differential relationship with T2DM and CVD. Our objective was to study the relationship of obesity measures with brachial and ankle SBPs. A population of 1098 adults (South Asians n = 699; 41.70% male and 58.3% female) were recruited over 5 years from primary care practices in England. Their four limbs SBPs were measured using Doppler machine and body-mass-index (BMI) and waist-to-height-ratio (WHtR) calculated. Linear regressions were performed between SBPs and obesity measures, after adjustments for sex, age, ethnicity, T2DM and CVD. The mean age of all participants was 51.3 (SD = 17.2), European was 57.7 (SD 17.2) and South Asian was 47.8 (SD = 16.1). The left posterior tibial [Beta = 1.179, P = 4.559 × 10−15] and the right posterior tibial SBP [Beta = 1.178, P = 1.114 × 10−13] most significantly associated with the BMI. In South Asians, although the left brachial [Beta = 25.775, P = 0.032] and right brachial SBP [Beta = 22.792, P = 0.045] were associated to the WHtR, the left posterior tibial SBP [Beta = 39.894, P = 0.023], association was the strongest. For the first time, we have demonstrated that ankle SBPs had significant association with generalised obesity than brachial systolic blood pressures (SBP), irrespective of ethnicity. However, with respect to visceral obesity, the association with ankle SBP was more significant in South Asians compared to Europeans.
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Wung CH, Lee MY, Wu PY, Huang JC, Chen SC. Obesity-Related Indices Are Associated with Peripheral Artery Occlusive Disease in Patients with Type 2 Diabetes Mellitus. J Pers Med 2021; 11:jpm11060533. [PMID: 34207835 PMCID: PMC8229333 DOI: 10.3390/jpm11060533] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/30/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
Type 2 diabetes mellitus (DM) is an increasing global health issue. Peripheral artery occlusive disease (PAOD) is a common complication of diabetes, and it is a complex and costly disease. The association between type 2 DM and obesity is well known, however, the relationship between obesity and PAOD in patients with type 2 DM has yet to be elucidated. Therefore, the aim of this study was to examine associations between obesity-related indices and PAOD in patients with type 2 DM. A total of 1872 outpatients with type 2 DM were recruited from two hospitals in southern Taiwan. An ankle–brachial index (ABI) < 0.9 in either leg was considered to indicate the presence of PAOD. The following obesity-related indices were investigated: conicity index (CI), waist–hip ratio (WHR), body roundness index (BRI), waist-to-height ratio (WHtR), abdominal volume index, a body shape index (ABSI), visceral adiposity index (VAI), lipid accumulation product (LAP), body adiposity index, body mass index and triglyceride–glucose index. Overall, 4.1% of the enrolled patients had an ABI < 0.9. High values of the following obesity-related indices were significantly associated with a low ABI: WHtR (p = 0.045), VAI (p = 0.003), CI (p = 0.042), BRI (p = 0.021) and ABSI (p = 0.043). Furthermore, WHR (area under the curve (AUC) = 0.661), CI (AUC = 0.660) and LAP (AUC = 0.642) had the best performance (all p < 0.001) to predict PAOD. In conclusion, high WHtR, BRI, CI, VAI and BAI values were associated with a low ABI in the enrolled patients, and WHR, CI and LAP were the most powerful predictors of PAOD.
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Affiliation(s)
- Chih-Hsuan Wung
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Mei-Yueh Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
| | - Pei-Yu Wu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Jiun-Chi Huang
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Szu-Chia Chen
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Correspondence: ; Tel.: +886-7-8036783 (ext. 3440); Fax: +886-7-8063346
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Shou Z, Zhao Y, Zhang Y, Li S. Risk factors for peripheral arterial disease in elderly patients with Type-2 diabetes mellitus: A clinical study. Pak J Med Sci 2020; 36:1344-1348. [PMID: 32968406 PMCID: PMC7501018 DOI: 10.12669/pjms.36.6.2906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives: To determine risk factors for peripheral arterial disease (PAD) in elderly patients with Type-2 diabetes mellitus. Methods: The elderly patients with Type-2 diabetes treated in the Central Hospital of Cangzhou were enrolled and divided into PAD group and non-PAD group between October 2016 and November 2019, The data of the patients including age, gender, body mass index, blood pressure, hemoglobin A1c, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, total cholesterol, triglyceride, white cell count, lymphocyte count, high-sensitivity C-reactive protein, uric acid as well as living habits and complications of Type-2 diabetes mellitus were recorded to determine the risk factors for PAD. Results: One thousand four hundred seventy six (1476) patients were enrolled, in which 465 patients were included in group of PAD, and 1011 in non-PAD group. The univariate analysis revealed that the two groups significantly differed in age (p=0.003), course of T2DM (p=0.001), hypertension (p=0.006), smoking habits (p<0.001), hyperuricemia (p<0.01), high-sensitivity C-reactive protein (p<0.01), white cell count (p<0.001), lymphocyte count (p<0.001) and diabetic neuropathy (p<0.001). In the multivariate analysis, age (OR: 1.56, 95% CI: 1.21-1.89), smoking habit (OR: 1.37, 95% CI: 1.19-1.68), hypertension (OR: 1.44, 95% CI: 1.15-1.98), diabetic neuropathy (OR: 3.55, 95% CI: 2.14-4.29), high-sensitivity C-reactive protein (OR: 1.74, 95% CI: 1.39-2.61) and hyperuricemia (OR: 2.71, 95% CI: 1.66-3.87) were significant risk factors for PAD. Conclusions: Age, smoking habit, hypertension, diabetic neuropathy, high-sensitivity C-reactive protein and hyperuricemia were independent risk factors for peripheral arterial disease in elderly patients with Type-2 diabetes mellitus.
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Affiliation(s)
- Zhang Shou
- Zhang Shou, Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061001, China
| | - Yongcai Zhao
- Yongcai Zhao, Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061001, China
| | - Yan Zhang
- Yan Zhang, Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061001, China
| | - Shaoqing Li
- Shaoqing Li, Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, 061001, China
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Agboghoroma OF, Akemokwe FM, Puepet FH. Peripheral arterial disease and its correlates in patients with type 2 diabetes mellitus in a teaching hospital in northern Nigeria: a cross-sectional study. BMC Cardiovasc Disord 2020; 20:102. [PMID: 32111165 PMCID: PMC7049182 DOI: 10.1186/s12872-020-01395-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 02/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is a risk factor for diabetic foot ulcer, limb amputation as well as coronary heart disease. It is more common in patients with diabetes mellitus (DM) and co-exists with peripheral neuropathy. Prevalence of PAD in type 2 DM patients in northern Nigeria is largely unknown. We investigated the occurrence and factors associated with PAD among patients with type 2 DM in a tertiary hospital in northern Nigeria. METHODS This was a cross- sectional analytic study. We recruited 200 patients with type 2 DM consecutively from the diabetes clinic of the Jos University Teaching Hospital. Ankle brachial index was assessed for each participant. Clinical information, anthropometric indices and blood samples were collected for assay. Data was analysed using CDC Epi-Info and logistic regression analysis was used to determine independent correlates of PAD. RESULTS PAD was present in 38.5%(n = 77) of subjects and it was associated with the female sex, age ≥ 50 years, Body mass index (BMI) ≥ 25 kg/m2 and low HDL cholesterol levels. However, on multiple logistic regression, a BMI ≥ 25 kg/m2 and a low HDL cholesterol level were independent correlates of PAD(adjusted OR = 2.13,95% CI = 1.04-4.36 and adjusted OR = 2.31, 95% CI = 1.04-5.15, respectively). CONCLUSION PAD is present in more than a third of patients with type 2 DM in a tertiary hospital in northern Nigeria. A BMI of ≥25 kg/m2 and low HDL cholesterol levels were independent correlates of PAD.
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Affiliation(s)
- Orighomisan Freda Agboghoroma
- Jos University Teaching Hospital, Jos, Plateau State Nigeria
- Present address: Medical Research Council at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Fatai Momodu Akemokwe
- Present address: Medical Research Council at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
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Circulating Angiogenic Growth Factors in Diabetes Patients with Peripheral Arterial Disease and Exertional Leg Pain in Ghana. Int J Vasc Med 2017; 2017:2390174. [PMID: 29445546 PMCID: PMC5763056 DOI: 10.1155/2017/2390174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Peripheral arterial disease (PAD) is a common complication of diabetes, associated with impairment in angiogenesis. Angiogenesis is regulated by angiogenic growth factors such as angiopoietin 1 (Ang-1), Ang-2, and vascular endothelial growth factor (VEGF). We studied the association between angiogenic growth factors versus PAD and exertional leg symptoms in diabetes patients in Ghana. Method In this cross-sectional study, ankle-brachial index was measured with oscillometrically and exertional leg symptoms were screened with Edinburgh claudication questionnaire in 140 diabetes patients and 110 nondiabetes individuals. Circulating levels of Ang-1, Ang-2, and VEGF were measured with immunosorbent assay. Results The prevalence of PAD and exertional leg pain was 16.8% and 24.8%, respectively. Compared to non-PAD participants, PAD patients had higher VEGF levels [85.8 (37.5–154.5) versus 57.7 (16.6–161.1) p = 0.032] and lower Ang-1 levels [31.3 (24.8–42.6) versus 40.9 (28.2–62.1), p = 0.017]. In multivariable logistic regression, patients with exertional leg pain had increased the odds of plasma Ang-2 levels [OR (95% CI): 2.08 (1.08–6.41), p = 0.036]. Conclusion Diabetes patients with PAD and exertional leg pain have imbalance in angiogenic growth factors, indicating impaired angiogenesis. In patients with exertional leg pains, Ang-2 may be an important biomarker.
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Chen L, Cai S, Li B, Jiang Q, Ke M, Zhao Y, Chen S, Zou M. A novel signal acquisition platform of human cardiovascular information with noninvasive method. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2017; 88:054301. [PMID: 28571401 DOI: 10.1063/1.4982952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardiovascular diseases (CVDs) are considered the major cause of death worldwide, so more researchers pay more and more attention to the development of a non-invasive method to obtain as much cardiovascular information (CVI) as possible for early screening and diagnosing. It is known that considerable brain information could be probed by a variety of stimuli (such as video, light, and sound). Therefore, it is quite possible that much more CVI could be extracted via giving the human body some special interrelated stimulus. Based on this hypothesis, we designed a novel signal platform to acquire more CVI with a special stimulus, which is to give a gradual decrease and a different settable constant pressure to six air belts placed on two-side brachia, wrists, and ankles, respectively. During the stimulating process, the platform is able to collect 24-channel dynamic signals related with CVI synchronously. Moreover, to improve the measurement accuracy of signal acquisition, a high precision reference chip and a software correction are adopted in this platform. Additionally, we have also shown some collection instances and analysis results in this paper for its reliability. The results suggest that our platform can not only be applied on study in a deep-going way of relationship between collected signals and CVDs but can also serve as the basic tool for developing a new noninvasive cardiovascular function detection instrument and system that can be used both at home and in the hospital.
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Affiliation(s)
- Longcong Chen
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Shaoxi Cai
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Bo Li
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Qifeng Jiang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Ming Ke
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Yi Zhao
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Sijia Chen
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
| | - Misha Zou
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, China
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Yeboah K, Kyei-Baafour E, Antwi DA, Asare-Anane H, Gyan B, Amoah AGB. Circulating angiogenic factors in diabetes patients in a tertiary hospital in Ghana. J Diabetes Metab Disord 2016; 15:44. [PMID: 27777900 PMCID: PMC5057505 DOI: 10.1186/s40200-016-0267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/04/2016] [Indexed: 11/27/2022]
Abstract
Background Impaired angiogenesis is amongst the underlining mechanisms of organ damage in diabetes and hypertensive patients. In diabetes and hypertensive patients without proteinuria and overt CVDs, we studied the levels of angiogenic growth factors, angiopoietin (Ang)-1, Ang-2 and vascular endothelial growth factor (VEGF), and the relationship between these angiogenic growth factors and renal function, measured as estimated glomerular filtration rate (eGFR). Method In a case control design, 107 type 2 diabetes (T2DM) patients and 93 non-diabetes controls were recruited into the study. Levels of plasma glucose, lipids, creatinine and angiogenic growth factors; Ang-1, Ang-2 and VEGF measured from fasting blood samples. Estimated glomerular filtration rate (eGFR) was computed using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) algorithm and eGFR < 60 ml/min/1.73 m2 was considered to be low. Multivariable logistic regression was used to assess the odds of change in angiogenic growth factors among patients with diabetes and hypertension, and patients with low eGFR, compared to those without these conditions. Results In a total of 200 participants with 49 % females and mean age of 54.1 ± 10.2 years, 22.7 % of T2DM patients and 13.3 % of non-diabetes participant had low eGFR. The levels of Ang-1 and Ang-2 were highest in hypertensive T2DM patients, followed by patients with either T2DM or hypertension alone, with the controls having the lowest levels. The odds of change in circulating Ang-2 levels increased in patients with both diabetes and hypertension [11.76 (7.97–16.63), p < 0.01] compared to patients with either diabetes [5.45 (3.31–9.71), p = 0.02] or hypertension [5.45 (3.31–9.71), p = 0.02] alone. Compared to those with normal eGFR, the odds of change in serum Ang-2 levels were increased in patients with low eGFR in both the crude [1.26 (1.08–2.110), p = 0.023] and adjusted [1.14 (1.03–2.34), p = 0.043] regression models. Conclusion In our study population, having diabetes and hypertension increased the levels of Ang-1 and Ang-2. Also, low eGFR status was associated with increased levels of Ang-2 after adjustment for other risk factors.
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Affiliation(s)
- Kwame Yeboah
- Department of Physiology, School of Biomedical and Allied Health Sciences, University of Ghana, P O Box KB143, Korle-Bu, Accra, Ghana
| | - Eric Kyei-Baafour
- Department of Immunology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Daniel A Antwi
- Department of Physiology, School of Biomedical and Allied Health Sciences, University of Ghana, P O Box KB143, Korle-Bu, Accra, Ghana
| | - Henry Asare-Anane
- Department of Chemical Pathology, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Ben Gyan
- Department of Immunology, Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Albert G B Amoah
- Department of Medicine & Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra, Ghana ; National Diabetes Management & Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana
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Yeboah K, Antwi DA, Gyan B, Govoni V, Mills CE, Cruickshank JK, Amoah AGB. Arterial stiffness in hypertensive and type 2 diabetes patients in Ghana: comparison of the cardio-ankle vascular index and central aortic techniques. BMC Endocr Disord 2016; 16:53. [PMID: 27680212 PMCID: PMC5041289 DOI: 10.1186/s12902-016-0135-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/21/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Diabetes and hypertension increase arterial stiffness and cardiovascular events in all societies studied so far; sub-Saharan African studies are sparse. We investigated factors affecting arterial function in Ghanaians with diabetes, hypertension, both or neither. METHOD Testing the hypothesis that arterial stiffness would progressively increase from controls to multiply affected patients, 270 participants were stratified into those with diabetes or hypertension only, with both, or without either. Cardio-ankle vascular index (CAVI), heart-ankle pulse wave velocity (haPWV), aortic PWV (PWVao) by Arteriograph, aortic and brachial blood pressures (BP), were measured. RESULTS In patients with both diabetes and hypertension compared with either alone, values were higher of CAVI (mean ± SD, 8.3 ± 1.2 vs 7.5 ± 1.1 and 7.4 ± 1.1 units; p < 0.05), PWVao (9.1 ± 1.4 vs 8.7 ± 1.9 and 8.1 ± 0.9 m/s; p < 0.05) and haPWV (8.5 ± 1 vs 7.9 ± 1 and 7.2 ± 0.7 m/s; p < 0.05) respectively. In multivariate analysis, age, having diabetes or hypertension and BMI were independently associated with CAVI in all participants (β = 0.49, 0.2, 0.17 and -0.2 units; p < 0.01, respectively). Independent determinants of PWVao were heart rate, systolic BP and age (β = 0.42, 0.27 and 0.22; p < 0.01), and for haPWV were systolic BP, age, BMI, diabetes and hypertension status (β = 0.46, 0.32, -0.2, 0.2 and 0.11; p < 0.01). CONCLUSION In this sub-Saharan setting with lesser atherosclerosis than the western world, arterial stiffness is significantly greater in patients with coexistent diabetes and hypertension but did not differ between those with either diabetes or hypertension only. Simple, reproducibly measured PWV/CAVI may offer effective and efficient targets for intervention.
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Affiliation(s)
- Kwame Yeboah
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P.O. Box KB 143, Accra, Ghana.
| | - Daniel A Antwi
- Department of Physiology, School of Biomedical & Allied Health Sciences, University of Ghana, P.O. Box KB 143, Accra, Ghana
| | - Ben Gyan
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Virginia Govoni
- Cardiovascular Medicine Group, Division of Diabetes and Nutrition, King's College and King's Health Partners, London, UK
| | - Charlotte E Mills
- Cardiovascular Medicine Group, Division of Diabetes and Nutrition, King's College and King's Health Partners, London, UK
| | - J Kennedy Cruickshank
- Cardiovascular Medicine Group, Division of Diabetes and Nutrition, King's College and King's Health Partners, London, UK
| | - Albert G B Amoah
- Department of Medicine and Therapeutics, School of Medicine and Dentistry, University of Ghana, Accra, Ghana
- National Diabetes Management and Research Centre, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
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Yeboah K, Antwi DA, Gyan B. Arterial Stiffness in Nonhypertensive Type 2 Diabetes Patients in Ghana. Int J Endocrinol 2016; 2016:6107572. [PMID: 27774104 PMCID: PMC5059649 DOI: 10.1155/2016/6107572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/31/2016] [Accepted: 06/26/2016] [Indexed: 12/03/2022] Open
Abstract
Background. Increased arterial stiffness is an independent cardiovascular risk factor in diabetes patients and general population. However, the contribution of diabetes to arterial stiffness is often masked by coexistent obesity and hypertension. In this study, we assessed arterial stiffness in nonhypertensive, nonobese type 2 diabetes (T2DM) patients in Ghana. Methods. In case-control design, 166 nonhypertensive, nonobese participants, comprising 96 T2DM patients and 70 nondiabetes controls, were recruited. Peripheral and central blood pressure (BP) indices were measured, and arterial stiffness was assessed as aortic pulse wave velocity (PWVao), augmentation index (AIx), cardioankle vascular index (CAVI), and heart-ankle pulse wave velocity (haPWV). Results. With similar peripheral and central BP indices, T2DM patients had higher PWVao (8.3 ± 1 versus 7.8 ± 1.3, p = 0.044) and CAVI (7.9 ± 1.2 versus 6.9 ± 0.7, p = 0.021) than nondiabetic control. AIx and haPWV were similar between T2DM and nondiabetic controls. Multiple regression models showed that, in the entire study participants, the major determinants of PWVao were diabetes status, age, gender, systolic BP, and previous smoking status (β = 0.22, 0.36, 0.48, 0.21, and 0.25, resp.; all p < 0.05); the determinants of CAVI were diabetes status, age, BMI, heart rate, HbA1c, total cholesterol, HDL cholesterol, and previous smoking status (β = 0.21, 0.38, 0.2, 0.18, 0.24. 0.2, -0.19, and 0.2, resp.; all p < 0.05). Conclusion. Our findings suggest that nonhypertensive, nonobese T2DM patients have increased arterial stiffness without appreciable increase in peripheral and central pressure indices.
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Affiliation(s)
- Kwame Yeboah
- Department of Physiology, School of Allied & Biomedical Sciences, University of Ghana, Accra, Ghana
- *Kwame Yeboah:
| | - Daniel A. Antwi
- Department of Physiology, School of Allied & Biomedical Sciences, University of Ghana, Accra, Ghana
| | - Ben Gyan
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
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