1
|
Dan HJ, Ji H, Zhou YQ, Li CY, Gao BL. Detection of Early Vascular Atherosclerosis in Type 2 Diabetes Mellitus Using Ultrasound Radiofrequency-Data Technique. J Stroke Cerebrovasc Dis 2021; 30:105751. [PMID: 33812173 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/27/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To quantitatively evaluate changes in vascular elasticity and intima-media thickness (IMT) of the common carotid artery (CCA) with Ultrasound radiofrequency (RF)-data technology in asymptomatic patients with type-2 diabetes mellitus (T2DM) and controls. MATERIALS AND METHODS Thirty-seven T2DM patients and 39 controls were enrolled. Arterial elasticity and CCA-IMT were quantitatively assessed by RF-data technology. The CCA diameters in the diastolic and systolic phases, carotid distensibility (CD), IMT, values of stiffness (β) and local pulse wave velocity (PWVβ) were measured and compared between the two groups. RESULTS The T2DM group had significantly larger CCA diastolic and systolic diameter, lower CD values, higher IMT measurements (all p < 0.001), and higher values of β and PWVβ (all P < 0.05) than the controls. Significant differences were not revealed in the mean values of IMT, β, PWVβ and CD across both sides of the CCA (all P > 0.05). CONCLUSIONS Higher IMT measurement and lower arterial elasticity of the CCA are significantly pronounced in asymptomatic T2DM patients and may suggest atherosclerotic changes, and the ultrasound RF-data technique may be used as a potential approach for detection of early-stage atherosclerosis.
Collapse
Affiliation(s)
- Hai-Jun Dan
- Departments of Physical Examination, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Hong Ji
- Department of Gland Surgery, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Ya-Qing Zhou
- Departments of Physical Examination, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Cai-Ying Li
- Department of Radiology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, Hebei Province 050000, China.
| | - Bu-Lang Gao
- Department of Radiology, The Second Hospital of Hebei Medical University, 215 West Heping Road, Shijiazhuang, Hebei Province 050000, China.
| |
Collapse
|
2
|
Dilating Vascular Diseases: Pathophysiology and Clinical Aspects. Int J Vasc Med 2018; 2018:9024278. [PMID: 30225143 PMCID: PMC6129317 DOI: 10.1155/2018/9024278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/29/2018] [Indexed: 01/22/2023] Open
Abstract
Atherosclerotic disease of the vessels is a significant problem affecting mortality and morbidity all over the world. However, dilatation of the vessels either in the arterial system or in the venous territory is another vessel disease. Varicocele, pelvic, and peripheral varicose veins and hemorrhoids are aneurysms of the venous vascular regions and have been defined as dilating venous disease, recently. Coronary artery ectasia, intracranial aneurysm, and abdominal aortic aneurysm are examples of arterial dilating vascular diseases. Mostly, they have been defined as variants of atherosclerosis. Although there are some similarities in terms of pathogenesis, they are distinct from atherosclerotic disease of the vessels. In addition, pathophysiological and histological similarities and clinical coexistence of these diseases have been demonstrated both in the arterial and in the venous system. This situation underlies the thought that dilatation of the vessels in any vascular territory should be considered as a systemic vessel wall disease rather than being a local disease of any vessel. These patients should be evaluated for other dilating vascular diseases in a systematic manner.
Collapse
|
3
|
The clinical value of anti-cyclic citrullinated peptide (anti-ccp) antibodies and insulin resistance (IR) in detection of early and subclinical atherosclerosis in rheumatoid arthritis (RA). Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
4
|
Morigami H, Morioka T, Yamazaki Y, Imamura S, Numaguchi R, Asada M, Motoyama K, Mori K, Fukumoto S, Shoji T, Emoto M, Inaba M. Visceral Adiposity is Preferentially Associated with Vascular Stiffness Rather than Thickness in Men with Type 2 Diabetes. J Atheroscler Thromb 2016; 23:1067-79. [PMID: 26947599 PMCID: PMC5090813 DOI: 10.5551/jat.33399] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: Visceral fat accumulation is known to underlie the clustering of cardiovascular risk factors. However, it is not completely understood how visceral fat accumulation influences the development of cardiovascular disease. In this study, we investigated the clinical impact of visceral adiposity on vascular stiffness and thickness in patients with type 2 diabetes (T2D). Methods: One hundred and sixty-one patients with T2D, including 92 men and 69 women, were included in this cross-sectional study. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured by dual bioelectrical impedance analysis. Stiffness parameter β and intima-media thickness (IMT) of the common carotid artery were measured by ultrasonography. Results: The mean age and duration of diabetes in the study population were 61 years and 13.9 years, respectively. In men, VFA and waist circumference (WC) were positively correlated with stiffness parameter β, whereas body mass index (BMI), WC, and SFA were negatively correlated with IMT. In contrast, in women, none of the obesity-related indices were significantly correlated with stiffness parameter β or IMT. In multiple regression analyses, VFA as well as WC, BMI, and SFA were independently associated with stiffness parameter β after adjustment for age and other potential confounders in men but not in women. None of the obesity-related indices were independently associated with IMT for either sex. Conclusion: In men with T2D, visceral adiposity is associated with carotid arterial stiffness but not thickness.
Collapse
Affiliation(s)
- Hirokazu Morigami
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Rathsman B, Rosfors S, Sjöholm A, Nyström T. Early signs of atherosclerosis are associated with insulin resistance in non-obese adolescent and young adults with type 1 diabetes. Cardiovasc Diabetol 2012. [PMID: 23185996 PMCID: PMC3538551 DOI: 10.1186/1475-2840-11-145] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Patients with type 1 diabetes have a substantial risk of developing cardiovascular complications early in life. We aimed to explore the role of insulin sensitivity (Si) as an early factor of atherosclerosis in young type 1 diabetes vs. non-diabetic subjects. Methods Forty adolescent and young adult individuals (20 type 1 diabetics and 20 non-diabetics), age 14–20 years, without characteristics of the metabolic syndrome, participated in this cross-sectional study. After an overnight fast, Si was measured by hyperinsulinemic euglycemic clamp (40 mU/m2) and calculated by glucose infusion rate (GIR). Carotid intima-media thickness (cIMT) was measured in the common carotid artery with high-resolution ultrasonography. Risk factors of atherosclerosis (Body mass index [BMI], waist circumference, systolic blood pressure [sBP], triglycerides, low HDL-cholesterol and HbA1c) were also investigated. Results cIMT was increased (0.52 ± 0.1 vs. 0.47 ± 0.1 mm, P < 0.01), whereas GIR was decreased (5.0 ± 2.1 vs. 7.1 ± 2.2 mg/kg/min, P < 0.01) in type 1 diabetics vs. non-diabetics. The differences in cIMT were negatively associated with Si (r = −0.4, P < 0.01) and positively associated with waist circumference (r = 0.34, P = 0.03), with no such associations between BMI (r = 0.15, P = 0.32), sBP (r = 0.09, P = 0.58), triglycerides (r = 0.07, P = 0.66), HDL-cholesterol (r = 0.10, P = 0.55) and HbA1c (r = 0.24, P = 0.13). In a multivariate regression model, between cIMT (dependent) and group (explanatory), only adjustment for Si affected the significance (ß = 0.08, P = 0.11) vs. (ß = 0.07, P < 0.01) for the whole model. No interaction between cIMT, groups and Si was observed. Conclusions cIMT is increased and associated with insulin resistance in adolescent, non-obese type 1 diabetic subjects. Although, no conclusions toward a causal relationship can be drawn from current findings, insulin resistance emerges as an important factor reflecting early signs of atherosclerosis in this small cohort.
Collapse
Affiliation(s)
- Björn Rathsman
- Karolinska Institutet, Department of Clinical Science and Education, Sachs' Childrens' Hospital, Södersjukhuset AB, Stockholm, SE-118 83, Sweden.
| | | | | | | |
Collapse
|
6
|
Affiliation(s)
- Fadi G Hage
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA.
| | | |
Collapse
|
7
|
Nabavi V, Ahmadi N, Bhatia HS, Flores F, Ebrahimi R, Karlsberg RP, Budoff MJ. Increased carotid wall thickness measured by computed tomography is associated with the presence and severity of coronary artery calcium. Atherosclerosis 2011; 215:103-9. [DOI: 10.1016/j.atherosclerosis.2010.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 11/09/2010] [Accepted: 11/25/2010] [Indexed: 01/07/2023]
|
8
|
Liu J, Cao TS, Duan YY, Yang YL, Yuan LJ. Effects of cold pressor-induced sympathetic stimulation on the mechanical properties of common carotid and femoral arteries in healthy males. Heart Vessels 2010; 26:214-21. [PMID: 21174209 DOI: 10.1007/s00380-010-0069-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 07/02/2010] [Indexed: 12/16/2022]
Abstract
Our aim was to evaluate the effects of sympathetic excitation and elevation of blood pressure on mechanical properties of common carotid and femoral arteries by wave intensity analysis (WIA). The diameters and arterial stiffness parameters of right common carotid artery (RCCA) and right common femoral artery (RCFA) in healthy young men were measured by WIA at baseline and during cold pressor test (CPT). In addition, the blood pressure and heart rate were recorded simultaneously. The heart rates and blood pressures increased during CPT compared with baseline, while the pulse pressures remained unchanged. The diameters of RCCA increased slightly, while those of RCFA did not change. The Peterson's pressure modulus (Ep), augment index (AI), and pulse wave velocity from β (PWVβ) increased obviously, while arterial compliance (AC) decreased with no change in stiffness index (β) of both arteries during CPT when compared with baseline. There was an obvious increase in pulse wave velocity from wave intensity (PWV_WI) of RCCA, while the PWV_WI of RCFA showed no significant change during CPT. The sympathetic nervous system exerts a more marked tonic restraint on RCFA than on RCCA. The Ep, AC, AI, PWVβ of RCCA, and RCFA are much affected by variations in blood pressure and sympathetic status, while the β of both arteries are less vulnerable to these factors and are more reliable in reflecting the actual arterial stiffness; The PWV_WI appears to be suitable only for evaluating the stiffness of RCCA instead of RCFA.
Collapse
Affiliation(s)
- Jie Liu
- Department of Ultrasound Diagnostics, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, China
| | | | | | | | | |
Collapse
|
9
|
Saitou M, Osonoi T, Kawamori R, Katakami N, Kaneto H, Matsuhisa M, Yamasaki Y. Genetic risk factors and the anti-atherosclerotic effect of pioglitazone on carotid atherosclerosis of subjects with type 2 diabetes--a retrospective study. J Atheroscler Thromb 2010; 17:386-94. [PMID: 20134102 DOI: 10.5551/jat.2527] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Pioglitazone, an agonist of peroxisome proliferator-activated receptor gamma, showed various anti-atherosclerotic effects on type 2 diabetic patients. This retrospective study was done to ascertain which risk factor(s) associate with anti-atherosclerotic effects of pioglitazone. METHODS We enrolled 160 diabetic patients treated through diet only and 62 treated with pioglitazone and annually evaluated carotid maximum (MaxIMT) and averaged intima-media thickness (AveIMT) for 2 years. We analyzed the relation of 99 single-nucleotide polymorphisms (SNP) as well as conventional risk factors with the progression or regression of carotid atherosclerosis. RESULTS The D allele of the angiotensin-converting enzyme (ACE) gene and 677 allele of the methylene-tetrahydrofolate reductase (MTHFR) gene showed a significant association with increases in MaxIMT among the diabetic subjects treated through diet only. The pioglitazone-treated carriers of the D allele showed an attenuation of MaxIMT as compared with the diet-treated carriers. The pioglitazone-treated carriers of the 677T allele carriers showed a significant attenuation of MaxIMT compared with the diet-treated carriers. CONCLUSIONS Pioglitazone may exert anti-atherosclerotic effects on type 2 diabetics carrying the ACE gene's D allele and/or MTHFR gene's 677T allele, who showed a progression of carotid atherosclerosis without the drug.
Collapse
|
10
|
Lee E, Emoto M, Teramura M, Tsuchikura S, Ueno H, Shinohara K, Morioka T, Mori K, Koyama H, Shoji T, Okuno Y, Inaba M, Nishizawa Y. The combination of IMT and stiffness parameter beta is highly associated with concurrent coronary artery disease in type 2 diabetes. J Atheroscler Thromb 2009; 16:33-9. [PMID: 19262000 DOI: 10.5551/jat.e605] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS The clinical implications of stiffness of the carotid artery (CA) have not been fully clarified in the prediction of coronary artery disease (CAD), although intima-media thickness (IMT) has been established as a surrogate marker. We examined the associations of stiffness parameter beta (ST) and IMT with concurrent CAD. METHODS IMT and ST were measured by ultrasound in 439 nondiabetic subjects as a control and 1528 type 2 diabetic subjects (T2DM) with or without CAD in a cross-sectional study. RESULTS Both IMT and ST significantly increased with age and group category, in the order of control, T2DM without CAD, and T2DM with CAD (p<0.001). The area under the curve on ROC analysis of ST for concurrent CAD was comparable to that for IMT. On multivariate logistic regression analysis, High IMT (>or=1.30 mm) and High stiffness (>or=20.0) had significant odds ratios for concurrent CAD (2.205, p<0.001 and 1.548, p<0.05, respectively). The group with High IMT and High Stiffness exhibited a stronger multivariate odds ratio (3.115, p=0.0001). CONCLUSIONS ST and IMT are associated with CAD and exhibited significant odds ratios for CAD. Our findings suggest that the combination of IMT and ST is a useful marker of atherosclerosis.
Collapse
Affiliation(s)
- Eiko Lee
- Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Abeno-ku, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Miyazaki T, Shimada K, Iwama Y, Kume A, Sumiyoshi K, Sato Y, Ohmura H, Watanabe Y, Mokuno H, Daida H. Insulin response to oral glucose load is associated with coronary artery disease in subjects with normal glucose tolerance. J Atheroscler Thromb 2008; 15:6-12. [PMID: 18270458 DOI: 10.5551/jat.e515] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The critical role of hyperinsulinemia, independent of hyperglycemia, in the pathogenesis of atherosclerosis has not been fully determined. We investigated the association between secretion patterns of insulin after oral glucose load and the severity of coronary artery disease (CAD) in patients with normal glucose tolerance (NGT). METHODS We enrolled 116 subjects with NGT from 243 patients who had undergone coronary angiography and a standard 75-g oral glucose tolerance test. The patients were divided into 0-vessel, single-vessel and multi-vessel disease groups on the basis of the severity of CAD. RESULTS The 2-h insulin levels in the multi-vessel disease group (p=0.005) and the single-vessel disease group (p<0.05) were significantly higher than those in the 0-vessel disease group. Multivariate analysis revealed that the levels of 2-h insulin were an independent variable for the presence of CAD (p=0.02) after adjustment for gender and the presence of each criterion of metabolic syndrome using the definition of the International Diabetes Federation. CONCLUSION A slight but significant increase in prolonged insulin secretion, which is associated with the early stage of insulin resistance, in subjects with NGT, may play an important role in the pathogenesis of atherosclerosis.
Collapse
Affiliation(s)
- Tetsuro Miyazaki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Mäkelä R, Loimaala A, Nenonen A, Mercuri M, Vuori I, Huhtala H, Oja P, Bond G, Koivula T, Lehtimäki T. The association of myeloperoxidase promoter polymorphism with carotid atherosclerosis is abolished in patients with type 2 diabetes. Clin Biochem 2008; 41:532-7. [PMID: 18280811 DOI: 10.1016/j.clinbiochem.2008.01.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Accepted: 01/22/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Type 2 diabetes mellitus (DM) enhances the development of atherosclerosis and reduces the activity of the oxidative myeloperoxidase (MPO) enzyme. MPO gene has a functional promoter polymorphism -463G/A which leads to high- (GG) and low-expression (AG, AA) genotypes. DESIGN AND METHODS We studied the association of MPO polymorphism with carotid artery intima-media thickness (IMT) in 198 randomly selected Finnish men of Caucasian origin, 161 non-diabetics and 37 with type 2 DM. Their carotid IMT was measured by high-resolution ultrasonography, and the overall mean IMT value was calculated. MPO genotypes were determined by the PCR-RFLP method. RESULTS We found significant MPO genotype-by-study-group (control/DM) interactions with the overall mean IMT and internal carotid IMT (p=0.05 and p=0.04, respectively). Among non-diabetic subjects, the overall carotid IMT was 7.3% higher in subjects with the low-activity genotype when compared to the high-activity (G/G) group. The results remained significant after adjustment for total cholesterol and smoking (p=0.015). No similar genotypic association was found for the subjects with type 2 DM. CONCLUSIONS This data suggests that in subjects with normal glucose metabolism, MPO gene variation may modify the carotid artery IMT.
Collapse
Affiliation(s)
- Riikka Mäkelä
- Tampere University Hospital, Centre for Laboratory Medicine, Department of Clinical Chemistry, Tampere, Finland.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Giannattasio C, Failla M, Capra A, Scanziani E, Amigoni M, Boffi L, Whistock C, Gamba P, Paleari F, Mancia G. Increased arterial stiffness in normoglycemic normotensive offspring of type 2 diabetic parents. Hypertension 2008; 51:182-7. [PMID: 18195169 DOI: 10.1161/hypertensionaha.107.097535] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetes is associated with a reduction of arterial distensibility. Limited information exists regarding whether or how early this appears in the course of the disease. We studied 54 normoglycemic, normotensive, healthy offspring of 2 parents with type 2 diabetes mellitus and 55 age- and sex-matched healthy control subjects. Carotid diastolic diameter and systodiastolic change were measured by echo tracking (Wall Track System) and wall thickness by echocolor Doppler (Sonos 5500, Philips). Pulse pressure was measured by a semiautomatic device positioned on the brachial artery and arterial distensibility calculated by Reneman formula. Blood pressure, blood glucose, glycohemoglobin, and insulin sensitivity (homeostasis model assessment index) were normal or only slightly elevated and by and large similar in the 2 groups. Compared with control subjects, offspring of diabetic parents showed similar carotid diameters at diastole and a reduced increase in carotid diameter at systole (-16%), a reduced carotid artery distensibility (-30%), and an increased pulse pressure (+21.8%), all differences being statistically significant (P<0.05) and persisting in subgroups with elevated or normal body mass index values (<25 and >or=25 kg/m(2)). Carotid artery wall thickness was not different between the 2 groups. Thus, subjects with predisposition to diabetes show carotid artery stiffening even in the absence of blood pressure alterations, as well as substantial alterations of glucose metabolism, body mass index, and changes in carotid wall thickness. This suggests that, in diabetes, alterations in arterial mechanical properties represent an early phenomenon, which may occur in the absence of metabolic and blood pressure alterations.
Collapse
|
14
|
Yetkin E, Waltenberger J. Novel insights into an old controversy: is coronary artery ectasia a variant of coronary atherosclerosis? Clin Res Cardiol 2007; 96:331-9. [PMID: 17453130 PMCID: PMC2775118 DOI: 10.1007/s00392-007-0521-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 02/12/2007] [Indexed: 01/26/2023]
Abstract
Coronary artery ectasia (CAE) is defined as a localized or diffuse non-obstructive lesion of the epicardial coronary arteries with a luminal dilation exceeding 1.5-fold the diameter of the normal adjacent arterial segment. The incidence of CAE has been reported to range between 2% and 4%, which might be an overestimation of the true frequency. The coincidence of CAE with other systemic vascular dilatations has suggested that the mechanism underlying CAE is not only localized to coronary arteries, but also to other vascular compartments such as aorta or peripheral veins. Although the pathophysiology of CAE remains largely unknown, it was supposed to represent a variant of coronary atherosclerosis. This review focuses on this controversy of whether CAE and coronary artery disease (CAD) are two manifestations of the same underlying process. There are clear differences between CAD and CAE with respect to cardiovascular risk factors such as diabetes mellitus, and pathogenic steps in disease progress such as inflammation or extracellular matrix remodeling. As this review will underscore, the current knowledge of the field is insufficient to finally clarify the causative interrelation between CAE and CAD. The clinical course and treatment of CAE mainly depends on its coexistence with CAD. When coexisting with CAD, the prognosis and treatment of CAE are the same as for CAD alone. In isolated CAE, prognosis is better and anti-platelet drugs are the mainstay of treatment. Surgical treatment can be considered in selected patients. For clarifying the mechanism underlying CAE, additional clinical, histopathological and pathophysiological investigations are required. In fact, every patient with CAE should be evaluated systematically for pathological changes in other vascular territories, both in the arterial system as well as in the venous system, which might occur in the disease process.
Collapse
Affiliation(s)
- Ertan Yetkin
- Department of Cardiology, University Hospital of Maastricht
and Cardiovascular Research Institute
of Maastricht (CARIM)
University of Maastricht, P. Debyelaan 25, 5800, 6202 AZ Maastricht, The Netherlands
| | - Johannes Waltenberger
- Department of Cardiology, University Hospital of Maastricht
and Cardiovascular Research Institute
of Maastricht (CARIM)
University of Maastricht, P. Debyelaan 25, 5800, 6202 AZ Maastricht, The Netherlands
| |
Collapse
|
15
|
Abstract
Initially considered as a semipermeable barrier separating lumen from vessel wall, the endothelium is now recognised as a complex endocrine organ responsible for a variety of physiological processes vital for vascular homeostasis. These include the regulation of vascular tone, luminal diameter, and blood flow; hemostasis and thrombolysis; platelet and leucocyte vessel-wall interactions; the regulation of vascular permeability; and tissue growth and remodelling. The endothelium modulates arterial stiffness, which precedes overt atherosclerosis and is an independent predictor of cardiovascular events. Unsurprisingly, dysfunction of the endothelium may be considered as an early and potentially reversible step in the process of atherogenesis and numerous methods have been developed to assess endothelial status and large artery stiffness. Methodology includes flow-mediated dilatation of the brachial artery, assessment of coronary flow reserve, carotid intimamedia thickness, pulse wave analysis, pulse wave velocity, and plethysmography. This review outlines the various modalities, indications, and limitations of available methods to assess arterial dysfunction and vascular risk.
Collapse
Affiliation(s)
- Helen A Lane
- Department of Endocrinology, University of Wales College of Medicine, Heath Park, Cardiff, Wales, UK.
| | | | | |
Collapse
|
16
|
Robert L, Labat-Robert J. The metabolic syndrome and the Maillard reaction. An introduction. ACTA ACUST UNITED AC 2006; 54:371-4. [PMID: 16978798 DOI: 10.1016/j.patbio.2006.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 07/04/2006] [Indexed: 11/18/2022]
Abstract
With the rapid increase of life expectancy in western societies, appeared also a new phenomenon, obesity, which took during the recent decades pandemic dimensions. One of the consequences was the appearance of type II diabetes in much younger persons than before. The result of intensive research in this field over the last decades led, among other achievements to the identification of biological and molecular symptoms which together were reclassified as the "metabolic syndrome". Questionable as far as its originality is concerned, it did however good service to practitioners by formulating criteria for diagnostic and therapeutical purposes. Among the underlying biochemical mechanisms the Maillard reaction, the non enzymatic glycosylation of proteins and nucleotide bases followed by the formation of advanced glycation and products (AGE-s) plays an important role. Several recent experimental results confirm this statement, some of them are published in this issue. The reviews and original contributions form together an up to date report on this important pathology and support again the importance of posttranslational and environmental factors influencing gene expression and cellular functions.
Collapse
Affiliation(s)
- L Robert
- Laboratoire de recherche en ophtalmologie, Hôtel-Dieu, université Paris-V, 1, place du Parvis-Notre-Dame, 75181 Paris cedex 04, France.
| | | |
Collapse
|
17
|
Araki T, Emoto M, Teramura M, Yokoyama H, Mori K, Hatsuda S, Maeno T, Shinohara K, Koyama H, Shoji T, Inaba M, Nishizawa Y. Effect of adiponectin on carotid arterial stiffness in type 2 diabetic patients treated with pioglitazone and metformin. Metabolism 2006; 55:996-1001. [PMID: 16839832 DOI: 10.1016/j.metabol.2006.03.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Accepted: 03/29/2006] [Indexed: 11/18/2022]
Abstract
Adiponectin, an adipocyte-specific plasma protein, has been reported to exhibit protective effects against atherosclerosis as well as an insulin-sensitizing effect. This study was designed to investigate the effect of adiponectin on carotid arterial stiffness in type 2 diabetic patients treated with pioglitazone and metformin. Twenty type 2 diabetic patients were enrolled and divided into 2 groups, a pioglitazone-treated group (n = 10) and a metformin-treated group (n = 10). Before and after intervention, plasma adiponectin levels were measured by enzyme-linked immunosorbent assay and carotid arterial stiffness was evaluated by the stiffness parameter beta, measured by ultrasound equipped with a phase-locked echo-tracking system. In the pioglitazone group, plasma adiponectin level significantly increased and stiffness parameter beta significantly decreased, whereas in the metformin group neither of these parameters changed significantly. The changes in stiffness parameter beta were significantly and inversely correlated with change in plasma adiponectin level after treatment with pioglitazone or metformin in the group of all subjects (r = -0.472, P = .036). In conclusion, the present study is the first to demonstrate that increase in adiponectin level after treatment with the insulin sensitizers pioglitazone and metformin may improve arterial stiffness in patients with type 2 diabetes mellitus.
Collapse
Affiliation(s)
- Takahiro Araki
- Metabolism, Endocrinology, and Molecular Medicine, Department of Internal Medicine, Osaka City University Graduate Medical School, Osaka 545-8585, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Kim C, Park J, Park J, Kang E, Ahn C, Cha B, Lim S, Kim K, Lee H. Comparison of body fat composition and serum adiponectin levels in diabetic obesity and non-diabetic obesity. Obesity (Silver Spring) 2006; 14:1164-71. [PMID: 16899797 DOI: 10.1038/oby.2006.133] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Clinical aspects of diabetes and obesity are somewhat different, even at similar levels of insulin resistance. The purpose of this study was to determine differences in body fat distribution and serum adiponectin concentrations in diabetic and non-diabetic obese participants. We were also interested in identifying the characteristics of insulin resistance in these two groups, particularly from the standpoint of adiponectin. RESEARCH METHODS AND PROCEDURES Adiponectin concentrations of 112 type 2 diabetic obese participants and 124 non-diabetic obese participants were determined. Abdominal adipose tissue areas and midthigh skeletal muscle areas were measured by computed tomography. A homeostasis model assessment of the insulin resistance score was calculated to assess insulin sensitivity. The relationships among serum adiponectin, body fat distribution, and clinical characteristics were also analyzed. RESULTS Both abdominal subcutaneous and visceral fat areas were higher in the non-diabetic obese group, whereas midthigh low-density muscle area was higher in the diabetic obese group. The homeostasis model assessment of the insulin resistance score was similar between groups, whereas serum adiponectin was lower in the diabetic obese group. Abdominal visceral fat (beta = -0.381, p = 0.012) was a more important predictor of adiponectin concentration than low-density muscle (beta = -0.218, p = 0.026) in cases of non-diabetic obesity, whereas low-density muscle (beta = -0.413, p = 0.013) was a better predictor of adiponectin level than abdominal visceral fat (beta = - 0.228, p = 0.044) in diabetic obese patients. DISCUSSION Therefore, factors involved in pathophysiology, including different serum adiponectin levels and body fat distributions, are believed to be responsible for differences in clinical characteristics, even at similar levels of insulin resistance in both diseases.
Collapse
Affiliation(s)
- Chulsik Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yongdong Severance Hospital, Yonsei University, College of Medicine, 146-92, Dogok-dong, Kangnam-ku, 135-720, Seoul, Korea
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Yoshitomi Y, Ishii T, Kaneki M, Tsujibayashi T, Sakurai SI, Nagakura C, Miyauchi A. Relationship between insulin resistance and effect of atorvastatin in non-diabetic subjects. J Atheroscler Thromb 2005; 12:9-13. [PMID: 15725690 DOI: 10.5551/jat.12.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although insulin resistance (IR) is present in non-diabetic subjects, it is unknown whether IR affects statin treatment. We assessed the relationship between IR and the changes of lipid profile in patients with hyperlipidemia treated by atorvastatin. METHODS Forty-four non-diabetic patients were included. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. We used the value of 2.5 as the threshold for IR. RESULTS High-density lipoprotein (HDL) cholesterol at baseline was lower and triglyceride (TG) at baseline was higher in the IR group than in the nonIR group (p < 0.05). Changes in all lipid measurements did not differ between the two groups. HOMA-IR was correlated with HDL cholesterol at baseline and at follow-up and correlated with TG at baseline and at follow-up (r = -0.40, r = -0.53, r = 0.38, r = 0.35, p < 0.01, respectively). However, HOMA-IR did not associate with changes in total cholesterol, low-density lipoprotein cholesterol, HDL cholesterol, and TG. CONCLUSION The IR did not affect the degree of reduction in cholesterol by atorvastatin in non-diabetic subjects. The IR may influence hypertriglyceridemia greater than the effect of atorvastatin in non-diabetic subjects.
Collapse
|
20
|
Yokoyama H, Tahara H, Emoto M, Fujiwara S, Araki T, Shinohara K, Hatsuda S, Maeno T, Shoji T, Koyama H, Shoji T, Nishizawa Y. The K469E polymorphism of the intercellular adhesion molecule-1 gene is associated with plasma fibrinogen level in type 2 diabetes. Metabolism 2005; 54:381-6. [PMID: 15736117 DOI: 10.1016/j.metabol.2004.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intercellular adhesion molecule-1 (ICAM-1) is involved in inflammation and development of atherosclerotic change of vascular endothelium. The aim of the present study is to investigate whether K469E polymorphism of the ICAM-1 gene is associated with various clinical factors including plasma fibrinogen in patients with type 2 diabetes. ICAM-1 gene polymorphism was examined using polymerase chain reaction and restriction enzyme analysis in 360 type 2 diabetic patients. Plasma fibrinogen levels and other clinical variables were measured as well as circulating soluble ICAM-1 (sICAM-1) levels by enzyme-linked immunosorbent assay. The distribution of ICAM-1 genotypes, EE, EK, and KK, was not significantly different between type 2 diabetes and 152 healthy control subjects. Among 3 groups according to ICAM-1 genotypes in type 2 diabetes, no difference was found in adiposity, glycemic control, lipid profile, insulin sensitivity evaluated by homeostasis model assessment, or sICAM-1. Regarding fibrinogen, the patients with E allele showed significantly lower plasma fibrinogen levels in a dose-dependent manner (P = .033). Spearman rank correlation analyses revealed that ICAM-1 genotype showed significant correlation with plasma fibrinogen level (P < .001). In multiple regression analysis, ICAM-1 genotype was independent contribution factor of plasma fibrinogen level as well as high-density lipoprotein-cholesterol and urinary albumin excretion (R2 = 0.148, P < .001). In conclusion, K469E polymorphism of the ICAM-1 gene had impact on plasma fibrinogen level independently of other clinical factors in 360 type 2 diabetic patients, suggesting that fibrinogen is a candidate which links the ICAM-1 gene polymorphism to atherosclerosis.
Collapse
Affiliation(s)
- Hisayo Yokoyama
- Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Zsuga J, Gesztelyi R, Török J, Kéki S, Bereczki D. Asymmetric dimethylarginine: A molecule responsible for the coexistence of insulin resistance and atherosclerosis via dual nitric oxide synthase inhibition. Med Hypotheses 2005; 65:1091-8. [PMID: 16125868 DOI: 10.1016/j.mehy.2005.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Accepted: 07/02/2005] [Indexed: 11/25/2022]
Abstract
Asymmetric dimethylarginine (ADMA) has been recently identified as the major endogenous inhibitor of soluble nitric oxide synthase. Its systemic accumulation was observed in conjunction with atherosclerosis and several cardiovascular and metabolic diseases. Here, we propose that ADMA causes insulin resistance by the inhibition of the neuronal isoform of nitric oxide synthase, while the simultaneously observed atherosclerosis is the consequence of endothelial nitric oxide synthase (NOS) inhibition. Our hypothesis rests on animal models in which experimental insulin resistance was induced by intraportal administration of non-selective and selective neuronal nitric oxide synthase inhibitors, N-methyl-L-arginine (L-NMMA) or 7-nitroindazole. In these models, loss of hepatic nitric oxide productions is presumed to hinder a very potent insulin sensitizing mechanism referred to as meal induced sensitization that is anatomically linked to the nitrergic fibers of the anterior hepatic plexus. Cause and effect relationship between ADMA and insulin resistance has been proposed previously by others however the nature of this relationship has not been elucidated in detail. In our hypothesis, we suggest that ADMA by inhibiting both the neuronal and the endothelial forms of NOS, results both in insulin resistance and in accelerated atherosclerosis, therefore ADMA is the molecule responsible for the coexistence of these two conditions. We also suggest animal models and human studies to test our hypothesis, the results of which may offer novel approaches in the prevention of insulin resistance and atherosclerosis.
Collapse
Affiliation(s)
- Judit Zsuga
- Department of Pharmacology and Pharmacotherapy, University of Debrecen H-4012 Debrecen, P.O. Box 12, Hungary.
| | | | | | | | | |
Collapse
|
22
|
Yokoyama H, Emoto M, Fujiwara S, Motoyama K, Morioka T, Koyama H, Shoji T, Inaba M, Nishizawa Y. Short-term aerobic exercise improves arterial stiffness in type 2 diabetes. Diabetes Res Clin Pract 2004; 65:85-93. [PMID: 15223220 DOI: 10.1016/j.diabres.2003.12.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2003] [Accepted: 12/26/2003] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To investigate whether: (1) aerobic exercise decreases arterial stiffness and (2) reduction in arterial stiffness is associated with improvement in insulin resistance in type 2 diabetes. METHODS Common carotid and femoral arterial stiffness was ultrasonographically evaluated using stiffness index beta in 23 type 2 diabetic subjects before and after a 3-week exercise protocol including ergometer and walking. Insulin sensitivity (Clamp-IR) was assessed using euglycemic-hyperinsulinemic clamp before and after the protocol. Arterial stiffness was also examined in steady hyperinsulinemic state during clamp. RESULTS Anthropometrical factors did not change following exercise. Clamp-IR tended to increase after exercise protocol (P = 0.061). Stiffness index beta decreased following exercise in both common carotid and femoral arteries (P = 0.020 and P < 0.001, respectively). DeltaClamp-IR was significantly correlated with the changes in stiffness index beta of both common carotid (P = 0.040) and femoral artery (P = 0.016). Divided into tertiles according to DeltaClamp-IR, decreases in stiffness index beta for both common carotid (P = 0.009) and femoral (P = 0.037) arteries was greater in tertile group with a higher DeltaClamp-IR. Hyperinsulinemia during clamp decreased stiffness index beta in both common carotid (P = 0.031) and femoral (P = 0.025) arteries before exercise, but these effects disappeared after the exercise protocol. CONCLUSIONS Short-term aerobic exercise significantly decreased arterial stiffness in both common carotid and femoral arteries, and the reduction of stiffness was associated with improvement of insulin resistance in type 2 diabetes.
Collapse
Affiliation(s)
- Hisayo Yokoyama
- Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Rajaram V, Pandhya S, Patel S, Meyer PM, Goldin M, Feinstein MJM, Neems R, Liebson PR, Fiedler BM, Macioch JE, Feinstein SB. Role of surrogate markers in assessing patients with diabetes mellitus and the metabolic syndrome and in evaluating lipid-lowering therapy. Am J Cardiol 2004; 93:32C-48C. [PMID: 15178515 DOI: 10.1016/j.amjcard.2004.02.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diabetes mellitus and the metabolic syndrome (MS) are reaching epidemic proportions in the United States, and cardiovascular disease continues to be the leading cause of death among patients with diabetes. A range of noninvasive screening tools may help reduce the morbidity and mortality of patients with diabetes because of early detection of subclinical cardiovascular disease and active monitoring of the effectiveness of therapy. Surrogate markers of subclinical disease include conventional and contrast-enhanced ultrasound imaging of carotid artery intima-media thickness (c-IMT), 2-dimensional echocardiography, coronary artery calcium imaging, cardiac magnetic resonance imaging, ankle-brachial indices, and brachial artery reactivity testing. Because these noninvasive imaging tools are relatively comfortable and entail relatively low risk to the patient, they are ideal for initial screening and for the repeated imaging that is required for monitoring the effectiveness of therapy. Moreover, when used in large numbers of patients with diabetes, prediabetes, and the MS, these imaging tools may be useful in developing and validating thresholds for the use of lipid-lowering therapy as well as clear therapeutic goals for this population. In addition, contrast-enhanced c-IMT scans now produce real-time images of the vasa vasorum and neovascularization of atherosclerotic plaque, potentially causing a paradigm shift in our view of the genesis of atherosclerosis and affecting treatment options for all populations. Thus, surrogate markers may not only help improve individual patient outcomes, they also may help direct scarce medical resources to maximize medical benefits, improve overall medical care, and minimize costs and untoward side effects.
Collapse
|