Abstract
BackgroundReactive hyperemia-peripheral arterial tonometry (RH-PAT) is a noninvasive and simple test for evaluating the endothelial function. There has been sparse evidence on the usefulness of the RH-PAT index (RHI) in predicting future cardiovascular diseases among diabetic patients.MethodsAsymptomatic diabetic patients with albuminuria were selected; their medical history and laboratory findings were evaluated every 3 to 4 months, respectively. The primary outcome was a composite of three-point major adverse cardiovascular events (3-point MACE): death from cardiovascular causes, acute coronary events, or nonfatal stroke. On the contrary, secondary outcomes included a composite of 3-point MACE, hospitalization for heart failure, or chronic kidney disease (CKD) progression. RHI was measured using the Endo-PAT2000 at the baseline. RHI < 1.67 was considered to indicate peripheral endothelial dysfunction (PED).ResultsIn total, 149 subjects were included (mean age, 61.8 ± 9.2 years; duration of diabetes was 12 years). During the follow-up period (median, 49.7 months), of the 149 subjects, primary outcomes were detected in 12 (1 [2.3%] and 11 [10.5%] of those without and with PED, respectively). The presence of PED in baseline measurements significantly increased both primary and secondary outcomes, following adjustment for age, sex, hypertension, glycated hemoglobin, low-density lipoprotein cholesterol, triglyceride, systolic blood pressure, baseline estimated glomerular filtration rate, overt proteinuria, duration of diabetes, premedical history of ischemic events, anti-platelet agents, and smoking history (hazard ratio [HR]: 10.95; 95% confidence interval CI 1.00–119.91 for the primary outcome; HR, 4.12; 95% CI 1.37–12.41 for secondary outcome). In addition, PED could predict secondary outcomes independent of the risk score according to the American College of Cardiology/American Heart Association (HR: 3.24; 95% CI 1.14–9.17).ConclusionsPED can independently predict future cardiovascular events among diabetic patients with albuminuria.
Highlights
Reactive hyperemia-peripheral arterial tonometry (RH-PAT) is a noninvasive and simple test for evaluat‐ ing the endothelial function
Patients were excluded if they had (i) a recent history of myocardial infarction, cerebral infarction, or hospitalization due to heart failure less than 3 months before the enrollment, (ii) typical anginal pain aggravated by exercise, (iii) any chest discomfort accompanied with dyspnea, or (iv) grade 3 hypertension (systolic blood pressure (SBP) ≥ 180 mmHg or diastolic blood pressure (DBP) ≥ 110 mmHg) [19]
Secondary outcomes included a composite of 3-point major adverse cardiovascular events (MACE), hospitalization for heart failure, or chronic kidney disease (CKD) progression
Summary
Reactive hyperemia-peripheral arterial tonometry (RH-PAT) is a noninvasive and simple test for evaluat‐ ing the endothelial function. There has been sparse evidence on the usefulness of the RH-PAT index (RHI) in predicting future cardiovascular diseases among diabetic patients. Reactive hyperemia-peripheral arterial tonometry (RH-PAT) is a simple, noninvasive, automatic test for evaluating the endothelial function [5, 6]. As RHI directly reflects endothelial function, it might estimate the residual ASCVD risk in diabetic subjects under appropriate medical treatment. There has been sparse evidence on the predictability of RHI in addition to conventional risk factors for future ASCVD among diabetic patients. A small-sized cross-sectional study [13] and a prospective study (less than 2 years) [14] reported no differences in RHI between the diabetic patients with and without coronary artery disease (CAD)
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