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van Agtmaal MJM, Houben AJHM, de Wit V, Henry RMA, Schaper NC, Dagnelie PC, van der Kallen CJ, Koster A, Sep SJ, Kroon AA, Jansen JFA, Hofman PA, Backes WH, Schram MT, Stehouwer CDA. Prediabetes Is Associated With Structural Brain Abnormalities: The Maastricht Study. Diabetes Care 2018; 41:2535-2543. [PMID: 30327356 DOI: 10.2337/dc18-1132] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/15/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Structural brain abnormalities are key risk factors for brain diseases, such as dementia, stroke, and depression, in type 2 diabetes. It is unknown whether structural brain abnormalities already occur in prediabetes. Therefore, we investigated whether both prediabetes and type 2 diabetes are associated with lacunar infarcts (LIs), white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and brain atrophy. RESEARCH DESIGN AND METHODS We used data from 2,228 participants (1,373 with normal glucose metabolism [NGM], 347 with prediabetes, and 508 with type 2 diabetes (oversampled); mean age 59.2 ± 8.2 years; 48.3% women) of the Maastricht Study, a population-based cohort study. Diabetes status was determined with an oral glucose tolerance test. Brain imaging was performed with 3 Tesla MRI. Results were analyzed with multivariable logistic and linear regression analyses. RESULTS Prediabetes and type 2 diabetes were associated with the presence of LIs (odds ratio 1.61 [95% CI 0.98-2.63] and 1.67 [1.04-2.68], respectively; P trend = 0.027), larger WMH (β 0.07 log10-transformed mL [log-mL] [95% CI 0.00-0.15] and 0.21 log-mL [0.14-0.28], respectively; P trend <0.001), and smaller white matter volumes (β -4.0 mL [-7.3 to -0.6] and -7.2 mL [-10.4 to -4.0], respectively; P trend <0.001) compared with NGM. Prediabetes was not associated with gray matter volumes or the presence of CMBs. CONCLUSIONS Prediabetes is associated with structural brain abnormalities, with further deterioration in type 2 diabetes. These results indicate that, in middle-aged populations, structural brain abnormalities already occur in prediabetes, which may suggest that the treatment of early dysglycemia may contribute to the prevention of brain diseases.
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Affiliation(s)
- Marnix J M van Agtmaal
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands .,School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Alfons J H M Houben
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Vera de Wit
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ronald M A Henry
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands.,Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Pieter C Dagnelie
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Epidemiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Carla J van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Annemarie Koster
- Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Social Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Simone J Sep
- Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, the Netherlands.,Department of Rehabilitation Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Abraham A Kroon
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jacobus F A Jansen
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Paul A Hofman
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Walter H Backes
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Mental Health and Neuroscience, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Miranda T Schram
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands.,Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.,School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands
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van Sloten TT, Czernichow S, Houben AJ, Protogerou AD, Henry RM, Muris DM, Schram MT, Sep SJ, Dagnelie PC, van der Kallen CJ, Schaper NC, Blacher J, Hercberg S, Levy BI, Stehouwer CD. Association Between Arterial Stiffness and Skin Microvascular Function: The SUVIMAX2 Study and The Maastricht Study. Am J Hypertens 2015; 28:868-76. [PMID: 25523296 DOI: 10.1093/ajh/hpu246] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/07/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND It has been hypothesized that arterial stiffness leads to generalized microvascular dysfunction and that individuals with type 2 diabetes mellitus (T2DM) are particularly prone to the detrimental effects of arterial stiffness. However, evidence for an association between stiffness and markers of generalized microvascular dysfunction is lacking. We therefore investigated the association between arterial stiffness and skin microvascular function in individuals without and with T2DM. METHODS Cross-sectional data were used of The Supplementation en Vitamines et Mineraux Antioxydants 2 (SUVIMAX2) Study (n = 284/62.2 years/48.6% women/0% T2DM (by design)) and The Maastricht Study (n = 737/59.7 years/45.2% women/28.8% T2DM (by design)). Arterial stiffness was determined by carotid-femoral pulse wave velocity (cfPWV). Skin capillaroscopy was used to determine capillary density at baseline, and during reactive hyperemia and venous congestion. Laser Doppler flowmetry was used to assess acetylcholine- and local heating-induced vasoreactivity, and skin flowmotion. RESULTS In The SUVIMAX2 Study, cfPWV (per +1 SD) was not associated with baseline capillary density (regression coefficient: -0.48 (95% confidence interval: 2.37; 1.41)) or capillary recruitment during venous congestion (0.54% (-0.74; 1.81%)). In addition, cfPWV was not associated with acetylcholine (-0.02% (-0.14; 0.10%)) or local heating-induced vasoreactivity (0.03% (-0.07; 0.12%)). In The Maastricht Study, in individuals without T2DM, cfPWV was not associated with baseline capillary density (-1.20 (-3.17; 0.77)), and capillary recruitment during reactive hyperemia (1.22% (-0.41; 2.84%)) or venous congestion (1.50% (-0.25; 3.25%)). In addition, cfPWV was not associated with flowmotion (-0.01 (-0.07; 0.06)). Results were adjusted for age and sex. Additional adjustments for confounders did not materially change these results. Results were qualitatively similar in individuals with T2DM. CONCLUSIONS Arterial stiffness is not associated with skin microvascular function, irrespective of the presence of T2DM.
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Affiliation(s)
| | | | - Alfons J Houben
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Athanase D Protogerou
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ronald M Henry
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dennis M Muris
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Miranda T Schram
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Simone J Sep
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Pieter C Dagnelie
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands; School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Epidemiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Carla J van der Kallen
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Nicolaas C Schaper
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands; School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jacques Blacher
- Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital, AP-HP, Paris Descartes University, Paris, France
| | - Serge Hercberg
- Nutritional Epidemiology Research Group, Sorbonne-Paris-Cité, UMR University of Paris 13/INSERM U557/INRA U1125/CNAM, Bobigny, France
| | - Bernard I Levy
- INSERM, UMS 011 Population-based cohorts, Villejuif, France
| | - Coen D Stehouwer
- Department of Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands;
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Sep SJ, van Kuijk SM, Smits LJ. Index event bias: problems with eliminating the paradox. J Stroke Cerebrovasc Dis 2014; 23:2464. [PMID: 25194743 DOI: 10.1016/j.jstrokecerebrovasdis.2014.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/04/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Simone J Sep
- Department of Medicine, Maastricht University, Maastricht, The Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
| | - Sander M van Kuijk
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Luc J Smits
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands; School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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