Abstract
The aim of this study was to assess the factors associated with impaired vascular function in patients with poorly controlled type 2 diabetes (DM2) with and without overt cardiovascular disease (CVD). Ninety-five patients with DM2 and poor glycemic control were recruited and divided into two groups: Group 1, with known CVD (n = 38), and Group 2, without CVD (n = 57). Patients in Group 2 were further subdivided into those with short (<5 years, group 2b) and long (>5 years, group 2a) diabetes duration. Subclinical markers of atherosclerosis were assessed. Glycemic control was similar in the two groups (HbA1c: 9.2% (1.5) vs. 9.4% (1.8), p = 0.44). In Group 1, lower FMD (3.13 (2.16)% vs. 4.7 (3.4)%, p < 0.05) and higher cIMT (1.09 (0.3) mm vs. 0.96 (0.2) mm, p < 0.05) was seen compared with Group 2, whereas PWV was similar (12.1 (3.4) vs. 11.3 (3.0) m/s, p = 0.10). Patients in Group 2b had significantly lower PWV and cIMT and higher FMD compared to Group 1 (p < 0.05). Among patients with poorly controlled T2D, more pronounced vascular dysfunction was present in those with overt macrovascular disease. In patients with T2D without known CVD, vascular dysfunction was associated with disease duration. The use of vascular indices for cardiovascular risk stratification in patients with T2D requires further study.
Highlights
Atherosclerotic cardiovascular disease (ASCVD) remains the main cause of death in patients with type 2 diabetes mellitus (DM2) and results in significant morbidity and increasing health care costs [1]
The mean duration of diabetes was similar between the groups
This study demonstrated that in poorly controlled patients with DM2, the presence of macrovascular disease was associated with more pronounced vascular dysfunction and higher Carotid intima media thickness measurement (cIMT)
Summary
Atherosclerotic cardiovascular disease (ASCVD) remains the main cause of death in patients with type 2 diabetes mellitus (DM2) and results in significant morbidity and increasing health care costs [1]. Many patients are already predisposed to significant cardiovascular risk even at the prediabetic stage [2]. They often remain asymptomatic and when they develop clinically evident CVD, their prognosis and outcomes are worse compared to individuals with CVD but without DM2 [3,4]. Hyperglycemia alters the protective mechanisms of the endothelium and leads to inflammatory damage of the endothelial wall, increased permeability, and a reduction in antiatherogenic vasodilators such as nitric oxide [7]. Endothelial dysfunction has been previously reported in patients with DM2 as well as prediabetes compared to healthy
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