Abstract
Background: Type 2 diabetes (DM2) and impaired glucose metabolism (IGM) are associated with an
increased cardiovascular disease risk. Impaired endothelial synthesis of nitric oxide
(NO) is an important feature of atherothrombosis and can be estimated from endothelium-dependent
flow-mediated dilation (FMD). It is controversial whether or not FMD is impaired in
DM2 and IGM. We investigated this issue in a population-based setting. Methods and results: In the study population (n=650; 246 with normal glucose metabolism (NGM), 135 with IGM and 269 with DM2; mean
age: 67.6 years), FMD and endothelium-independent nitroglycerine-mediated dilation
(NMD) were ultrasonically estimated from the brachial artery and expressed as the
absolute change in diameter in mm. The increase in diameter (mean ± standard deviation)
in NGM, IGM and DM2 was 0.19±0.15, 0.19±0.18 and 0.13±0.17 for FMD and 0.45±0.21,
0.43±0.24 and 0.45±0.25 for NMD. After adjustment for age, sex, baseline diameter
and percentage increase in peak systolic velocity, DM2, as compared to NGM, remained
associated with impaired FMD (regression coefficient β (95%CI)) as compared to NGM, −0.06 mm (−0.09 to −0.03). IGM was not associated with impaired FMD (β, 0.01 mm (−0.02 to 0.04)). Additional adjustment for conventional cardiovascular risk factors
did not alter these associations. Hyperglycemia or hyperinsulinemia explained 2% of
the association between DM2 and FMD. NMD was not associated with glucose tolerance.
Conclusions: This study shows that DM2 is independently associated with impaired FMD. Hyperglycemia
and hyperinsulinemia contribute minimally to this association. Impaired FMD may therefore,
in part, explain the increased cardiovascular disease risk in DM2, whereas the normal
FMD in IGM suggests that other forms of endothelial dysfunction are important in explaining
the increased cardiovascular disease risk in IGM.
Keywords
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Article info
Publication history
Accepted:
January 5,
2004
Received in revised form:
December 9,
2003
Received:
September 29,
2003
Identification
Copyright
© 2004 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
