Abstract
Brachial-ankle pulse wave velocity (baPWV) provides a useful means of assessing cardiovascular events and diabetic complications. However, the nature of associations between baPWV and microalbuminuria (MAU) and its presence in Type 2 diabetes mellitus (Type 2 DM) have rarely been investigated. This study aimed to examine the association between baPWV and MAU coupled with prediction of MAU using baPWV measurement among Type 2 DM patients. In this cross-sectional study, we enrolled 424 Type 2 DM patients who visited the cardiology and endocrinology department at a tertiary level health care facility, Republic of Korea between 1 January 2006 to 31 December 2008. Clinical and laboratory data were collected, and risk factors associated with MAU and prediction of risk for the development of MAU using baPWV measurement. The association between MAU and baPWV was examined using multivariable logistic regression analysis and predicted MAU by using receiver operating characteristic (ROC) curve analysis. Of the 424 Type 2 DM patients, 93 (21.9%) had MAU (20–200 μg/min). baPWV (cm/sec) was found to be significantly correlated with MAU levels (ug/min) (r = 0.791, p < 0.001). Further, baPWV was significantly associated MAU with higher odds ratio (adjusted odds ratio (AOR) 10.899; 95% confidence interval (CI) (4.518–26.292)). Similarly, smoking (AOR 5.736; 95% CI (1.036–31.755)), and low-density lipoprotein (LDL)-cholesterol (mg/dL) (AOR 1.017; 95% CI (1.001–1.033)) were also significantly associated with MAU. The appropriate cut-off value for baPWV to predict MAU 20 μg/min in our study was 1700 cm/sec (area under ROC curve = 0.976). This study shows that baPWV, cigarette smoking, and LDL-cholesterol are associated with MAU in Type 2 DM patients and suggests that a baPWV cut-off of 1700 cm/sec could be used to predict the presence of MAU (20 μg/min) in Type 2 DM patients in the Korean community.
Highlights
Diabetes mellitus is a global public health problem
This study shows that brachial-ankle pulse wave velocity (baPWV), cigarette smoking, and low-density lipoprotein (LDL)-cholesterol are associated with MAU in Type 2 DM patients and suggests that a baPWV cut-off of 1700 cm/sec could be used to predict the presence of MAU (20 μg/min) in Type 2 DM patients in the Korean community
One theory is that insulin resistance is common among patients with diabetes or dyslipidemia and results from endothelial dysfunction triggered by metabolic processes [10,11,12], while another posits that generalized vascular dysfunction due to arterial stiffness may result in MAU [13,14]
Summary
Diabetes mellitus is a global public health problem. In 2016, an estimated 1.6 million deaths were caused by diabetes and the number affected is predicted to increase to 552 million by 2030 [1,2].In addition to increasing morbidity and mortality, Type 2 diabetes mellitus (Type 2 DM) is considered to be an independent risk factor of many cardiovascular illnesses, such as coronary artery disease, and peripheral artery disease [3,4,5]. Microalbuminuria (MAU) is a clinical condition that can lead to proteinuria and cause endothelial dysfunction and atherosclerosis, and these conditions can increase arterial stiffness in Type 2 DM [6,7]. MAU has been reported to be positively associated with increased risks of cardiovascular morbidity and mortality independently of conventional cardiovascular risk factors in Type 2 DM [8]. MAU has been reported to be an important risk factor for the development of cardiovascular diseases and for increased mortality among the general population, and even at borderline level of microalbumin in general populations are reported to be significantly increased risk of death [9]. One theory is that insulin resistance is common among patients with diabetes or dyslipidemia and results from endothelial dysfunction triggered by metabolic processes [10,11,12], while another posits that generalized vascular dysfunction due to arterial stiffness may result in MAU [13,14]
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