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Abstract
Background
Pulse wave velocity (PWV) correlates with arterial distensibility and stiffness and is a useful method for evaluating the severity of systemic atherosclerosis in adults. Brachial-ankle PWV (baPWV) is affected by many different factors such as age, systolic blood pressure (SBP), sex, body mass index, waist to hip ratio, and HbA1c. We evaluated the determinants of baPWV in patients with type 2 diabetes mellitus.
Methods
The study included 803 type 2 diabetic patients over age 30 who had their ankle brachial pressure index (ABI) and baPWV measured at Busan St. Mary's Medical Center, Busan, Korea. Anthropometric parameters, blood pressure, pulse pressure, fasting plasma glucose, fasting insulin, HbA1c, lipid profile, high sensitivity C-reactive protein (hs-CRP), and microalbuminuria were checked concurrently. We also investigated tobacco and alcohol use by means of questionnaire. We then retrospectively analyzed the relationships between baPWV and various risk factors.
Results
Differences between men and women were measured using the independence sample probate. Pearson correlation analysis confirmed the factors affecting the baPWV as follows: SBP, diastolic blood pressure, pulse pressure, age, waist circumference, gender, and duration of diabetes mellitus were positively correlated, and height and weight were negatively correlated. On aged-adjusted partial correlation, HbA1c, SBP, diastolic blood pressure, and pulse pressure were correlated. By multiple linear regression analysis, SBP, age, HbA1c, and weight were independent predictors of baPWV.
Figures and Tables
Table 1
Comparison of clinical characteristics of patients underwent brachial ankle pulse wave velocity
Data are expressed in the mean ± SD. p value < 0.05 were considered significant. BMI, body mass index; Smoking, current smoker; ABI, Ankle-Brachial pressure index; ba-PWV, brachial Ankle pulse wave velocity; BP, blood pressure; HDL, high density lipoprotein; LDL, low density lipoprotein; Cre, Creatinine; hsCRP, high sensitivity C-reactive protein; DM, diabetes mellitus.
Table 2
The correlations between maximal brachial ankle pulse wave velocity (baPWV) and other variables
p values < 0.05 were considered significant. *Pearson's correlation coefficient. †Standard coefficient. M, male; F, female; BMI, body mass index; ABI, ankle-brachial pressure index; BP, blood pressure; HDL, high density lipoprotein; LDL, low density lipoprotein; Cre, creatinine; hsCRP, high sensitivity C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; rGTP, gamma glutamyl transpeptidase.
Table 3
The correlations between maximal brachial ankle pulse wave velocity (baPWV) and other variables according to sex
p-values < 0.05 were considered significant. *Pearson's correlation coefficient. M, male; F, female; BMI, body mass index; ABI, ankle-brachial pressure index; BP, blood pressure; HDL, high density lipoprotein; LDL, low density lipoprotein; Cre, creatinine; DM, diabetes mellitus; hsCRP, high sensitivity C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase; rGTP, gamma glutamyl transpeptidase; Smoking, current smoker.
References
1. McGovern PG, Pankow JS, Shahar E, Doliszny KM, Folsom AR, Blackburn H, Luepker RV. Recent trends in acute coronary heart disease-mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Intestigators. N Eng J Med. 1996. 334:884–890.
2. Ridker PM, Rifai N, Rose L, Burning JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol level in the prediction of first cardiovascular events. N Engl J Med. 2002. 347:1557–1565.
3. Laurent S, Boutouyrie P, Asmar R, Gautier I, Laloux B, Guize L, Ducimetiere P, Benetos A. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001. 37:1236–1241.
4. Timer O, Sestier F, Levy E. Metabolic syndrome X: a review Can. Cardiol. 2000. 16:779–789.
5. Alexander CM, Landsman PB, Teutsch SM, Haffner SM. NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes. 2003. 52:1210–1214.
6. O'Neal DN, Dragicevic G, Rowley KG, Ansari MZ, Balazs N, Jennkins A, Best JD. A cross-sectional study of the effects of type 2 diabetes and other cardiovascular risk factor on structure and function of nonstenotic arteries of the lower limb. Diabetes Care. 2003. 26:199–205.
7. Sun K, Daimon M, Watanabe S, Komuro I, Masuda Y. The relation of pulse wave velocity by oscillometric and tonometric methods and clinical application studies. Jpn J Appl Physiol. 2002. 32:81–86.
8. Oliver JJ, Webb DJ. Noninvasive assessment of arterial stiffness and risk of atherosclerotic events. Atheroscler Thromb Vasc Biol. 2003. 23:554–566.
9. Munakata M, Ito N, Nunokawa T, Toshinaga K. Utility of automated brachial ankle pulse wave velocity measurements in hypertensive patients. Am J Hypertens. 2003. 16:653–657.
10. Kubo T, Miyata M, Minago S, Setoyama S, Maruyama I, Tei C. A simple oscillometric technique for determining new indices of arterial distensibility. Hypertens Res. 2002. 25:351–358.
11. Benetos A, Waeber B, Izzo J, Mitchell G, Resnick L, Asmar R, Safar M. Influence of age, risk factor and renal disease on arterial stiffness: clinical applications. Am J Hypertens. 2002. 15:1101–1108.
12. American Diabetic Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004. 27:5–10.
13. Shoji T, Emoto M, Shinohara K, Kakiya R, Tsujimoto Y, Kishimoto H, Ishimura E, Tabata T, Nishizawa Y. Diabetes mellitus, aortic stiffness, and cardiovascular mortality in end-stage renal disease. J Am Soc Nephrol. 2001. 12:2117–2124.
14. de Angelis L, Millasseau SC, Smith A, Viberti G, Jones RH, Ritter JM, Chowienczyk PJ. Sex difference in age-related stiffening of the aorta in subjects with type 2 diabetes. Hypertension. 2004. 44:67–71.
15. Choi KM, Lee KW, Sul HR, Seo JA, Oh JH, Kim SG, Kim NH, Baik SH, Choi DS. Brachial-ankle pulse wave velocity in Koreans with metabolic syndrome. J Kor Diabetes Assoc. 2004. 28:36–44.
16. Safar Michel E., Edward D. Frohlich: The arterial system in hypertension: a prospective view. Hypertension. 1995. 26:10–14.
17. Hiatt William R. Medical treatment of peripheral arterial disease and claudication. N Engl J Med. 2001. 344:1608–1621.
18. Dormandy JA, Rutherford RB. Management of peripheral arterial disease(PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg. 2000. 31:S1–S296.
19. Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac A, Target R, Levy B. Assessment of arterial distensibility by automatic pulse wave velocity measurement: validation and clinical application studies. Hypertension. 1995. 26:485–490.
20. Yokoyama H, Hirasawa K, Aoki T, Ishiyama M, Koyama K. Brachial-ankle pulse wave velocity measured automatically by oscillometric method is elevated in diabetic patients with incipient nephropathy. Diabet Med. 2003. 20:942–945.
21. Kim KM, Kang SH, Cho DH, Kang HC, Chung DJ, Chung MY. Relationship between clinical course and measures of atherosclerosis in diabetic foot. Korean J Med. 2006. 70:361–370.
22. Ohmori K, Emura S, Takashima T. Risk factors of atherosclerosis and aortic pulse wave velocity. Angiology. 2000. 51:53–60.
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