Abstract
BackgroundPresence of Diabetes Mellitus increases the risk of subclinical atherosclerosis. In this study was aimed to determine the influence of hypertension (HTN) on surrogate markers of atherosclerosis in a population of patients with early type 2 diabetes.Methods125 diabetic subjects drawn from Dr. Shariati outpatient’s clinic list and 153 non- diabetic subjects who were the relatives in law of diabetic participants were recruited. Participants with type 2 diabetes were free of clinical evidence of cardiovascular disease and renal involvement. Two groups of diabetic and control were further divided into two subgroups of hypertensive (known case of HTN or blood pressure ≥140/90 mmHg) and normotensive, and anthropometric characteristics, metabolic biomarkers as well as markers of subclinical atherosclerosis including Carotid intima media thickness (CIMT), flow mediated dilation (FMD) and Ankle Brachial Index (ABI) were measured.ResultsDiabetic group with a mean age of 49.9 ± 7.5 years had significantly higher CIMT (0.64 ± 0.14 vs 0.76 ± 0.19, p = 0.001) and lower FMD (16.5 ± 8.1 vs 13.3 ± 7.1, p = 0.003) and ABI (1.2 ± 0.1 vs 1.1 ± 0.1, p = 0.01) than control with mean age of 52.9 ± 10.1 years. 34% of control and 59.2% of diabetic were hypertensive. Fasting blood sugar, insulin levels and calculated insulin resistance index of HOMA IR. of hypertensive subjects were higher than normotensive subjects in both groups of diabetic and non-diabetic. Similar pattern was presented for measured inflammatory mediators of hs-CRP and IL-6. Among subclinical atherosclerosis markers, only CIMT was significantly different between hypertensive and normotensive subjects in both groups. In adjusted linear regression analysis, a constant significant association existed between age and CIMT, ABI and FMD in non-diabetic, while in diabetic, age only correlated with CIMT and not the other two markers. In multiple regression model, HTN was recognized as a risk factor for increasing CIMT (OR = 2.93, 95% CI = 1.03-8.33, p = 0.04) but not attenuating FMD or ABI.ConclusionsSince FMD and CIMT may measure a different stage of subclinical atherosclerosis in diabetic patients, influence of HTN on these markers might be different.
Highlights
Type 2 diabetes mellitus (T2DM) is a chronic disease that comprises an array of dysfunctions resulting from the combination of resistance to insulin action and inadequate insulin secretion
Diabetic subjects presented with significantly higher levels of high sensitive Creactive Protein (hs-CRP) compared to control group. 34% (n = 52) of control group and 59.2% (n = 74) of diabetic subjects were hypertensive (p = 0.001)
The means of three measured subclinical atherosclerosis indexes of carotid intima-media thickness measurement (CIMT), flow-mediated dilatation test (FMD) and ankle-brachial index (ABI) were remarkably different between two groups of diabetic and control
Summary
Type 2 diabetes mellitus (T2DM) is a chronic disease that comprises an array of dysfunctions resulting from the combination of resistance to insulin action and inadequate insulin secretion. Patients with diabetes are in need of continuous medical care and self-management education to prevent acute complications and reduce the risk of longterm complications. Recognition of asymptomatic atherosclerosis in diabetes would be certainly important in reducing the risk of diabetic macrovascular complication and improvement of the prognosis. Clinical manifestations of atherosclerosis occur mainly in coronary arteries, lower extremity arteries, and carotid arteries. Atherosclerosis can be assessed using non-invasive techniques, such as carotid intima-media thickness measurement (CIMT) [3], brachial artery flow-mediated dilatation test (FMD) [4] and ankle-brachial index (ABI) [5,6]. Presence of Diabetes Mellitus increases the risk of subclinical atherosclerosis. In this study was aimed to determine the influence of hypertension (HTN) on surrogate markers of atherosclerosis in a population of patients with early type 2 diabetes
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