Pulse Wave Velocity In Type Research Articles

The performance of lipid profiles and ratios as a predictor of arterial stiffness measured by brachial-ankle pulse wave velocity in type 2 diabetic patients.

Background: Early identification of arterial stiffness in Type 2 diabetes mellitus (T2DM) patients before the manifestation of atherosclerosis would be clinically beneficial. Our study aimed to explore the correlation of lipid profiles and ratios with arterial stiffness, and construct a predictive model for arterial stiffness in T2DM patients using those parameters. Methods: One hundred and eighty-four adult T2DM patients in the diabetes outpatient clinic at the Dr. Soetomo general academic hospital were enrolled in this cross-sectional study in 2015 and 2019. Sociodemographic, glycosylated hemoglobin (HbA1c), lipid profiles, and brachial-ankle pulse wave velocity (ba-PWV) data were collected from all subjects. The subjects were divided into a group with arterial stiffness (ba-PWV > 18 m/sec) and without arterial stiffness (ba-PWV ≤ 18 m/sec). A correlation test was used to evaluate the association, and receiver operator characteristics (ROC) curves analysis were used to determine the cut-off value, sensitivity, and specificity. The risk analysis model was calculated using bivariate logistic regression analysis. Results: The group with arterial stiffness had higher lipid profiles: total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and lipid ratios. A significant positive correlation was found between TC, TG, LDL-C, and all lipid ratios with ba-PWV. A negative correlation was found between HDL-C and ba-PWV. All lipid ratio parameters can be used as predictors of arterial stiffness, especially non-HDL-C with cut-off value: 150 mg/dL (sensitivity 96.8% and specificity 52.9%) and TG/HDL-C ratio with cut-off value: 4.51 (sensitivity 81.0% and specificity 74.2%). Elevated TG/HDL-C ratio and non-HDL-C displayed higher risk (OR: 12.293 and 16.312; p < 0.05) of having arterial stiffness compared to other lipid ratios. Conclusions: Lipid profiles and lipid ratios, especially TG/HDL-C ratio and non-HDL-C, are potential biochemical markers for arterial stiffness in T2DM patients.

The performance of lipid profiles and ratios as a predictor of arterial stiffness measured by brachial-ankle pulse wave velocity in type 2 diabetic patients

Background: Early identification of arterial stiffness in Type 2 diabetes mellitus (T2DM) patients before the manifestation of atherosclerosis would be clinically beneficial. Our study aimed to explore the correlation of lipid profiles and ratios with arterial stiffness, and construct a predictive model for arterial stiffness in T2DM patients using those parameters. Methods: One hundred and eighty-four adult T2DM patients in the diabetes outpatient clinic at the Dr. Soetomo general academic hospital were enrolled in this cross-sectional study in 2015 and 2019. Sociodemographic, glycosylated hemoglobin (HbA1c), lipid profiles, and brachial-ankle pulse wave velocity (ba-PWV) data were collected from all subjects. The subjects were divided into a group with arterial stiffness (ba-PWV &gt; 18 m/sec) and without arterial stiffness (ba-PWV ≤ 18 m/sec). A correlation test was used to evaluate the association, and receiver operator characteristics (ROC) curves analysis were used to determine the cut-off value, sensitivity, and specificity. The risk analysis model was calculated using bivariate logistic regression analysis. Results: The group with arterial stiffness had higher lipid profiles: total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and lipid ratios. A significant positive correlation was found between TC, TG, LDL-C, and all lipid ratios with ba-PWV. A negative correlation was found between HDL-C and ba-PWV. All lipid ratio parameters can be used as predictors of arterial stiffness, especially non-HDL-C with cut-off value: 150 mg/dL (sensitivity 96.8% and specificity 52.9%) and TG/HDL-C ratio with cut-off value: 4.51 (sensitivity 81.0% and specificity 74.2%). Elevated TG/HDL-C ratio and non-HDL-C displayed higher risk (OR: 12.293 and 16.312; p &lt; 0.05) of having arterial stiffness compared to other lipid ratios. Conclusions: Lipid profiles and lipid ratios, especially TG/HDL-C ratio and non-HDL-C, are potential biochemical markers for arterial stiffness in T2DM patients.

Time in range, assessed with continuous glucose monitoring, is associated with brachial-ankle pulse wave velocity in type 2 diabetes: A retrospective single-center analysis.

The aim of this retrospective single-center is to research the relationship between time in range(TIR), an important novel metric of glycemic control, assessed with continuous glucose monitoring(CGM) and brachial-ankle pulse wave velocity(BaPWV), a unique index of systemic arterial stiffness in type 2 diabetes. Study participants included 469 hospitalized patients with type 2 diabetes and no history of serious cardiovascular disease who underwent CGM and BaPWV measurements. TIR of 3.9-10.0 mmol/L was evaluated with CGM. BaPWV was measured by non-invasive arteriosclerosis detector and high baPWV was defined as a mean baPWV≧1800m/s. The spearman correlation and the partial correlation analysis were applied to analyze the correlation between TIR and baPWV. The binary logistic regression was used to examine the independent association of TIR and high BaPWV. The presence of high baPWV was 32.2%. Compared with patients of low baPWV, those with high baPWV had significantly reduced TIR(P<0.001). With the increase of TIR tertiles, the prevalence of high BaPWV progressively decreased. Correlation analysis showed that TIR is inversely correlated with BaPWV. In a fully adjusted model controlling for traditional risk factor of CVD, TIR is associated with the presence of high BaPWV independent of HbA1c. TIR is correlated with BaPWV independent of HbA1c in patients with type 2 diabetes, confirming a link between TIR and arterial stiffness.

Factors Affecting Pulse Wave Velocity in Type 2 Diabetic Patients

Factors Affecting Pulse Wave Velocity in Type 2 Diabetic Patients

Renal Function, Albumin-Creatinine Ratio and Pulse Wave Velocity Predict Silent Coronary Artery Disease and Renal Outcome in Type 2 Diabetic and Prediabetic Subjects.

Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre-diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure. To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD. We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD. All type 2 DM patients were under antidiabetic treatment with A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, coronary angiography was performed. In addition, PWV, glomerular filtration rate, and ACR were evaluated. mean±SEM, and ANOVA among groups. 48.59% of DM2 and 25.58% of GI patients had silent coronary artery had silent coronary artery disease and higher ACR, PWV and reduced GFR. Higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and <60ml.min (p<0.05) in patients with CAD, suggesting a cardio-renal interaction in DM2. Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors as in DM2. Diabetic and prediabetics still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease.

Lower intake of saturated fatty acids is associated with persistently higher arterial stiffness in patients with type2 diabetes.

Aims/IntroductionThere are few studies to investigate the relationship between macronutrients and longitudinal changes in arterial stiffness in patients with type 2 diabetes mellitus. This exploratory study sought to determine whether macronutrients were correlated with increased arterial stiffness independently of conventional atherosclerotic risk factors.Materials and MethodsThe study participants comprised 733 type 2 diabetes outpatients who had no apparent history of cardiovascular diseases. The dietary schedule was assessed with a validated, brief, self‐administered diet history questionnaire. At baseline and at years 2 and 5, brachial‐ankle pulse wave velocity was measured. A multivariable linear mixed‐effects model was used to determine the predictive values of macronutrients and atherosclerotic risk factors for longitudinal changes in brachial‐ankle pulse wave velocity.ResultsThere was a significant increase in brachial‐ankle pulse wave velocity values over the 5‐year follow‐up period. In a multivariable linear mixed‐effects model that adjusted for age and sex, lower saturated fatty acid intake was significantly correlated with persistently higher brachial‐ankle pulse wave velocity, independently of other atherosclerotic risk factors. Lower intake of dairy products in particular showed this correlation.ConclusionsOur data showed that lower saturated fatty acids intake was correlated with persistently higher brachial‐ankle pulse wave velocity in type 2 diabetes patients. Among food sources of saturated fatty acids, lower dairy products specifically were correlated with elevated brachial‐ankle pulse wave velocity. This might be because the consumption of dairy products in Japan is much lower than in Western countries.

452-P: Albumin/Creatinine Ratio and Pulse Wave Velocity Predicts Coronary Artery Disease and Renal Outcome in Type 2 Diabetic and Prediabetic Subjects

Introduction: Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and prediabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure. Aims: To evaluate the incidence of coronary heart disease (CHD) and its relationship with urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CHD. Methods: We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CHD. All type 2 DM patients were under hypoglycemic treatment with an A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, a coronary angiography was performed. In addition, a PWV, glomerular filtration rate (CrCl), and ACR were evaluated. Statistics: mean±SEM, and ANOVA followed by Post Hoc analysis among groups. Results: Silent CHD was found in 48.59% of DM2 and 25.58% of GI. DM2 and GI patients with CHD had higher ACR and PWV and reduced glomerular filtration rate (p&amp;lt;0.05). DM2 and GI showed a negative relationship between GFR and ACR (p&amp;lt;0.05). Type 2 diabetic and GI showed a negative relation between GFR and ACR or PWV when having GFR above 60 mil.min. Meanwhile, in type 2 Diabetics with CHD and GFR &amp;lt; 60 ml.min a negative relationship with PWV was only, suggesting a cardiorenal interaction in type 2 diabetes. Conclusions: Higher PWV, lower GFR and ACR predict the incidence of CHD in DM2. GI also represent a group of higher risk for coronary heart disease with the same predictors showed in DM2. PWV seems to represent a reliable marker. Disclosure R.A. Sanchez: None. M.J. Sanchez: None. A.J. Ramirez: None.

Assessment of Metabolic Syndrome and Clinical Significance of Brachial-Ankle Pulse Wave Velocity in Type 2 Diabetes Mellitus Patients

Abstract Background and Aims: Metabolic syndrome (MS) is a constellation of various CVD risk factors comprised of abdominal obesity, glucose intolerance, hyperinsulinemia, hypertension and dyslipidemia. The present study was aimed to assess the prevalence of MS in type 2 diabetes mellitus (T2DM) patients, and to evaluate the clinical significance of brachial-ankle pulse wave velocity in these patients. Methods: The sample comprised of 251 T2DM patients. MS was evaluated in all the studied subjects according to NCEP-ATP III, IDF and JIS criteria. The subjects were screened for demographic as well as clinical characteristics. Results: Prevalence of MS was estimated to be 65%, 69% and 75% according NCEP-ATP-III, IDF and JIS criteria respectively. JIS criteria was only preceded for further analysis as it explained the highest prevalence and also showed the better level of agreement (0.862) with IDF criteria. Abdominal obesity was the most frequent component of MS in the studied subjects. Moreover, 20.21% of MS subjects were found to have very high risk of cardiovascular disease (CVD) / future mortality according to different combinations of brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI). Conclusions: The study revealed an increased prevalence of MS in the studied subjects. Risk of CVD may be better explained when these subjects were segregated according to different combinations of baPWV and ABI.

Carotid femoral pulse wave velocity in type 2 diabetes and hypertension: capturing arterial health effects of step counts.

Objective:Optimal medication use obscures the impact of physical activity on traditional cardiometabolic risk factors. We evaluated the relationship between step counts and carotid-femoral pulse wave velocity (cfPWV), a summative risk indicator, in patients with type 2 diabetes and/or hypertension.Research design and methods:Three hundred and sixty-nine participants were recruited (outpatient clinics; Montreal, Quebec; 2011–2015). Physical activity (pedometer/accelerometer), cfPWV (applanation tonometry), and risk factors (A1C, Homeostatic Model Assessment–Insulin Resistance, blood pressure, lipid profiles) were evaluated. Linear regression models were constructed to quantify the relationship of steps/day with cfPWV.Results:The study population comprised 191 patients with type 2 diabetes and hypertension, 39 with type 2 diabetes, and 139 with hypertension (mean ± SD: age 59.6 ± 11.2 years; BMI 31.3 ± 4.8 kg/m2; 54.2% women). Blood pressure (125/77 ± 15/9 mmHg), A1C (diabetes: 7.7 ± 1.3%; 61 mmol/mol), and low-density lipoprotein cholesterol (diabetes: 2.19 ± 0.8 mmol/l; without diabetes: 3.13 ± 1.1mmol/l) were close to target. Participants averaged 5125 ± 2722 steps/day. Mean cfPWV was 9.8 ± 2.2 m/s. Steps correlated with cfPWV, but not with other risk factors. A 1000 steps/day increment was associated with a 0.1 m/s cfPWV decrement across adjusted models and in subgroup analysis by diabetes status. In a model adjusted for age, sex, BMI, ethnicity, immigrant status, employment, education, diabetes, hypertension, medication classes, the mean cfPWV decrement was 0.11 m/s (95% confidence interval −0.2, −0.02).Conclusions:cfPWV is responsive to step counts in patients who are well controlled on cardioprotective medications. This ability to capture the ‘added value’ of physical activity supports the emerging role of cfPWV in arterial health monitoring.

Abstract 543: Increased Aortic Pulse Wave Velocity in Type 2 Diabetic db/db Mice is Dependent on Blood Pressure

Pulse wave velocity (PWV) is the gold standard for in vivo aortic stiffness measurements but can be dependent upon blood pressure and/or heart rate. Previous studies from our and other labs have shown increased aortic PWV in type 2 diabetic db/db mice. Moreover, preliminary ex vivo pressure myography data from our lab has also shown a lack of increase in passive aortic stiffness, suggesting that increased PWV in vivo , and therefore, increased stiffness in db/db mice may be dependent upon other mechanisms. In this study, we tested the hypothesis that increased aortic pulse wave velocity measured in db/db mice in vivo is blood pressure dependent under anesthesia. 16-wk old normal Db/db (n=9) and type 2 diabetic db/db (n=5) mice were anesthetized with 2% isoflurane and instrumented with two 1.2F pressure-tip catheters: one inserted in the left carotid artery and advanced to the thoracic aorta, the other inserted into the left femoral artery and advanced into the abdominal aorta. Blood pressure was continuously recorded and PWV was calculated using the foot-to-foot method. A microcannula was inserted into the right jugular vein for the administration of drugs. After a stabilization period of 25-30 mins, baseline BPs and PWVs were measured, after which mice were infused with increasing doses of phenylephrine (Phe, 100-500 nmol/kg/min) and sodium nitroprusside (SNP, 100-500 nmol/kg/min) to increase and decrease blood pressure, respectively. At baseline (prior to the infusion of any drugs), mean arterial pressure and aortic PWV were significantly elevated in db/db mice under anesthesia (MAP; Db/db: 77±5 vs. db/db: 100±4 mmHg, p &lt;0.05; PWV; Db/db: 0.31±0.01 vs. db/db: 0.35±0.01 cm/ms, p &lt;0.05). The increase in aortic PWV in db/db mice at baseline was completely abrogated when measured at equivalent MAPs ranging from 40-120 mmHg during the Phe and SNP infusions ( p &gt;0.05). In both Db/db and db/db mice, aortic PWV was significantly correlated with MAP (Db/db: r=0.94, p &lt;0.001; db/db: r=0.97, p &lt;0.0001). These data show that increased aortic PWV, and therefore increased aortic stiffness in db/db mice in vivo is dependent upon blood pressure.

24-h ambulatory pulse wave velocity and central blood pressure in type 2 diabetes

BackgroundPulse wave analysis from a brachial cuff permits ambulatory measurements of pulse wave velocity (PWV) and central blood pressure parameters. The diurnal variation of PWV in type 2 diabetes is unknown. MethodsWe evaluated the Arteriograph24 which is a brachial cuff based equipment for estimating PWV and central blood pressure data without the use of a transfer function, in 22 type 2 diabetic patients, who had two 24 h measurements performed. ResultsThe mean number of valid day time and nighttime measurements were 29 (range 16–50) and 18 (11–25), respectively. 21 patients had at least one qualifying report. Nighttime PWV was significantly lower than during the day (9.1 vs. 9.7 ± 0.8 mm/s, p < 0.01). Systolic aortic blood pressure was 6 mmHg lower than brachial blood pressure in the day time (p < 0.01) and 4 mmHg lower during the night (p < 0.05). Each single measurement was standardized with the 24 h average as reference thus generating data from 1004 paired observations. The standardized PWV correlated with standardized values of heart rate (r = 0.24, p < 0.001) and systolic aorta blood pressure (r = 0.20, p < 0.001). A stepwise multiple regression model with standardized pulse wave velocity as dependent variable included standardized heart rate, systolic aorta blood pressure and a dummy variable for day/night status (R2 = 0.091, p < 0.001). ConclusionThe Arteriograph24 is applicable for research purpose. PVW in type 2 diabetes is modestly reduced during the night. The intraindividual variation of heart rate contributed independently to the variation of PWV.

The clinical significance of IMT and PWV in type 2 diabetic patients

Objective To investigate the relationship between intima-media thickness(IMT)and pulse wave velocity(PWV)in patients with type 2 diabetes mellitus.Methods 100 cases with type 2 diabetes were randomly divided into:hydrochlorothiazide group of 35 cases,valsartan group of 35 cases,valsartan and hydrochlorothiazide combined treatment group(combined group)30 cases.All the patients were treated for 16 weeks,systolic blood pressure (SBP),diastolic blood pressure(DBP),24h urinary albumin,blood urea nitrogen(BUN),carotid IMT,PWV,fasting plasma glucose(FPG)were measured before and after treatment in each group.Results The SBP,DBP,24h urinary albumin before treatment compared with after treatment was significant differences in three groups(t =2.7875,2.755,2.733,2.645,all P ＜ 0.05); IMT associated with SBP(r =0.669,P =0.013),pulse pressure(r =0.581,P =0.015),FPG(r =0.337,P =0.018);PWV associated with SBP(r =0.759,P =0.001),pulse pressure(r =0.707,P=0.002),FPG(r =0.679,P =0.016).Conclusion The non-invasive indicators of PWV can be used as aortic compliance.The PWV measurement of its vascular complications has important clinical value. Key words: Diabetes mellitus; Intima-media thickness; Pulse wave velocity

Letter: The Effect of an Angiotensin Receptor Blocker on Arterial Stiffness in Type 2 Diabetes Mellitus Patients with Hypertension (Diabetes Metab J 2011;35:236-42)

We appreciate the interest and comments on our study, The effect of an angiotensin receptor blocker on arterial stiffness in type 2 diabetes mellitus patients with hypertension, which was published in Diabetes & Metabolism Journal 2011;35:236-242. Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease. In type 2 diabetes, hypertension often initiates and accelerates the progression of macrovascular events by increasing arterial stiffness [1,2]. Increased arterial stiffness was recently reported to be a powerful and independent risk factor for early mortality and had more clinical prognostic value than previously identified cardiovascular disease risk factors such as age, gender, smoking and dyslipidemia [3]. Previous studies have reported that angiotensin II type 1 receptor blockers reduce arterial stiffness [4-6]. In our study we assessed changes in central aortic waveforms and pulse wave velocity (PWV) as well as related parameters after treatment with valsartan in patients with type 2 diabetes and hypertension. We excluded patients concomitantly using insulin, thiazolidinedion or metformin as insulin resistance is associated with arterial stiffness and premature vascular sclerosis [7,8]. Our group of study subjects was homogeneous in terms of diabetes treatment, which had a minimal effect on insulin resistance. As Dr. Kim noted, our study has some limitations. There was no control group treated with other anti-hypertensive agents and confounding factors, such as lipid-lowering drugs, antiplatelet agents, and smoking, were not considered in the analysis. We were unable to measure PWV in all participants and the potential selection bias and diminished statistical power due to the small number of subjects was another limitation of this study. Although data was not shown in the article, there was no difference in baseline PWV values between the 'PWV decrease' and 'no PWV decrease' groups (11.0±1.8 vs. 10.5±2.0, P=0.297), and baseline PWV values were not associated with fasting blood glucose or HbA1c (P=0.462, P=0.641). We thought that if the number of subjects were larger, there might be association between them. Because there have been reported that fasting glucose and HbA1c were associated with PWV in type 2 diabetes patients with hypertension [9]. In our results, the baseline glucose level was significantly higher in 'no PWV decrease group.' Therefore, we concluded that the change in PWV was associated with baseline glycemic control status. Also, there were no differences between the two groups in terms of systolic or diastolic blood pressure at 12 weeks (P=0.183, P=0.396) or drug compliance, which was verified at every patient visit. Thus a difference in blood pressure control was excluded as a factor influencing the difference in PWV between the two groups. The results of our study suggested that the angiotensin receptor blocker, valsartan, had a modest beneficial effect in reducing arterial stiffness measured as PWV and the augmentation index in patients with type 2 diabetes and hypertension. Fasting glucose and HbA1c levels are likely to be independently associated with PWV improvement as a result of valsartan treatment. In future, further trials are needed to validate the effect observed in our study, to examine its stability over longer periods of follow-up, and to compare it with that obtained with other antihypertensive agents commonly used in clinical practice, and evaluate the pathogenic mechanism.

Relationship between Cardiac Autonomic Neuropathy and Brachial-ankle Pulse Wave Velocity in Type 2 Diabetics

Relationship between Cardiac Autonomic Neuropathy and Brachial-ankle Pulse Wave Velocity in Type 2 Diabetics

Response: The Effect of an Angiotensin Receptor Blocker on Arterial Stiffness in Type 2 Diabetes Mellitus Patients with Hypertension (Diabetes Metab J 2011;35:236-42)

We appreciate the interest and comments on our study, "The effect of an angiotensin receptor blocker on arterial stiffness in type 2 diabetes mellitus patients with hypertension," which was published in Diabetes & Metabolism Journal 2011;35:236-242. Hypertension and type 2 diabetes mellitus are major risk factors for cardiovascular disease. In type 2 diabetes, hypertension often initiates and accelerates the progression of macrovascular events by increasing arterial stiffness [1,2]. Increased arterial stiffness was recently reported to be a powerful and independent risk factor for early mortality and had more clinical prognostic value than previously identified cardiovascular disease risk factors such as age, gender, smoking and dyslipidemia [3]. Previous studies have reported that angiotensin II type 1 receptor blockers reduce arterial stiffness [4-6]. In our study we assessed changes in central aortic waveforms and pulse wave velocity (PWV) as well as related parameters after treatment with valsartan in patients with type 2 diabetes and hypertension. We excluded patients concomitantly using insulin, thiazolidinedion or metformin as insulin resistance is associated with arterial stiffness and premature vascular sclerosis [7,8]. Our group of study subjects was homogeneous in terms of diabetes treatment, which had a minimal effect on insulin resistance. As Dr. Kim noted, our study has some limitations. There was no control group treated with other anti-hypertensive agents and confounding factors, such as lipid-lowering drugs, antiplatelet agents, and smoking, were not considered in the analysis. We were unable to measure PWV in all participants and the potential selection bias and diminished statistical power due to the small number of subjects was another limitation of this study. Although data was not shown in the article, there was no difference in baseline PWV values between the 'PWV decrease' and 'no PWV decrease' groups (11.0±1.8 vs. 10.5±2.0, P=0.297), and baseline PWV values were not associated with fasting blood glucose or HbA1c (P=0.462, P=0.641). We thought that if the number of subjects were larger, there might be association between them. Because there have been reported that fasting glucose and HbA1c were associated with PWV in type 2 diabetes patients with hypertension [9]. In our results, the baseline glucose level was significantly higher in 'no PWV decrease group.' Therefore, we concluded that the change in PWV was associated with baseline glycemic control status. Also, there were no differences between the two groups in terms of systolic or diastolic blood pressure at 12 weeks (P=0.183, P=0.396) or drug compliance, which was verified at every patient visit. Thus a difference in blood pressure control was excluded as a factor influencing the difference in PWV between the two groups. The results of our study suggested that the angiotensin receptor blocker, valsartan, had a modest beneficial effect in reducing arterial stiffness measured as PWV and the augmentation index in patients with type 2 diabetes and hypertension. Fasting glucose and HbA1c levels are likely to be independently associated with PWV improvement as a result of valsartan treatment. In future, further trials are needed to validate the effect observed in our study, to examine its stability over longer periods of follow-up, and to compare it with that obtained with other antihypertensive agents commonly used in clinical practice, and evaluate the pathogenic mechanism.

Soluble tumor necrosis factor receptor 2 is independently associated with pulse wave velocity in nonobese Japanese patients with type 2 diabetes mellitus

The aim of the present study was to investigate the factors contributing to pulse wave velocity (PWV) in patients with type 2 diabetes mellitus. We focused on tumor necrosis factor (TNF) including soluble TNF receptors (sTNF-R1, sTNF-R2) in this study because TNF seems to be associated with the progression of atherosclerosis and because the relationships between PWV and TNF were not yet examined in type 2 diabetic patients. Univariate regression analyses showed that PWV was positively correlated with age ( r = 0.492, P < .001), diabetes duration ( r = 0.251, P = .021), systolic ( r = .595, P < .001) and diastolic ( r = 0.248, P = .022) blood pressure, antihypertensive medication ( r = 0.268, P = .013), and the concentrations of sTNF-R1 ( r = 0.354, P = .001) and sTNF-R2 ( r = 0.415, P < .001). Although there was a positive correlation between TNF- α and sTNF-R1 ( r = 0.382, P < .001) or sTNF-R2 ( r = 0.394, P < .001), TNF- α was not associated with PWV. Other variables including gender were not associated with PWV. Multiple regression analyses showed that PWV was independently predicted by the level of age (F = 15.1), systolic blood pressure (F = 31.6), and sTNF-R2 (F = 5.2), which explained 49.2% of the variability of PWV. From these results, it can be concluded that serum soluble TNF receptor is an important independent factor associated with aortic PWV in type 2 diabetic patients.

Effects of green tea consumption on inflammation, insulin resistance and pulse wave velocity in type 2 diabetes patients

In this study, we examined the effects of green tea on inflammation and arterial stiffness in type 2 diabetes patients. As results, inflammatory markers, such as hsCRP and IL-6, were unchanged after green tea consumption, and neither were blood glucose, lipid profiles, insulin resistance, or serum adiponectin levels. Furthermore, tea consumption did not improve baPWV. These results suggest that the above-described mechanisms are unlikely to explain the cardiovascular risk reduction by tea consumption observed in epidemiological studies.

A short-term admission improved brachial–ankle pulse wave velocity in type 2 diabetic patients

Brachial–ankle pulse wave velocity (baPWV) is a non-invasive method for assessing arterial stiffness associated with atherosclerosis. We examined whether baPWV could improve during a 2-week hospital-based education program in patients with type 2 diabetes and whether improvement associates with changes in known atherogenic risk factors. Body mass index (BMI), blood pressure (BP), fasting plasma glucose (FPG), insulin, lipid profiles and baPWV were measured in 32 type 2 diabetic patients before and after an educational program that included advice about nutrition and exercise. Relationship between the changes in baPWV and additional parameters, 24 h-urinary excretion of C-peptide, visceral and subcutaneous fat area by abdominal computer tomography and intima-medial thickness (IMT) of the carotid artery by ultrasonography, were also evaluated. Baseline values of baPWV significantly correlated with age, duration of diabetes, BP, IMT and FPG. BaPWV significantly decreased after the program (−120 ± 108.4 cm/s, P < 0.0001) and this change significantly correlated with that of systolic BP ( r = 0.697, P < 0.0001) and FPG ( r = 0.452, P < 0.05). These results indicate that short-term hospitalization with an educational program can improve arterial wall stiffness, perhaps due to improvements in BP and glycemic control.

Age-dependent relation of serum sialic acid concentration to aortic pulse wave velocity in type 2 diabetes

The purpose of this study was to determine whether age affects the significance of serum sialic acid concentration as a marker of atherosclerosis in patients with diabetes. In this cross-sectional study, we investigated the relationship of serum sialic acid concentration to aortic pulse wave velocity (a-PWV) and the effects of age on this relationship in patients with type 2 diabetes. In the elderly (70 years or over) diabetic patients, a-PWV showed a significant positive correlation with serum sialic acid. This relationship was also significant after adjustment for age, duration of diabetes, body mass index, systolic blood pressure, LDL cholesterol, HDL cholesterol and fibrinogen levels. In elderly diabetic patients, a-PWV also showed a significant positive correlation with age and duration of diabetes and a significant negative correlation with serum HDL cholesterol level. On the other hand, in the younger (31-60 years) diabetic patients, there was no significant correlation between serum sialic acid level and a-PWV, while a-PWV showed significant positive correlations with age, duration of diabetes and plasma fibrinogen level. Serum sialic acid level reflects atherosclerosis in elderly diabetic patients but not in younger diabetic patients. This may explain recent controversial findings regarding the relationship between serum sialic acid level and incidence of coronary heart disease in diabetes.