Relationship between metabolic syndrome components and vascular properties in Japanese type 2 diabetic patients without cardiovascular disease or nephropathy

Arterial Stiffness and the Canonical WNT/β-catenin Pathway

PURPOSE OF REVIEW

Arterial stiffness (AS) was mainly associated with cardiovascular morbidity and mortality in a hypertensive patient. Some risk factors contribute to the development of AS, such as aging, high blood pressure, vascular calcification, inflammation, and diabetes mellitus. The WNT/β-catenin pathway is implicated in numerous signaling and regulating pathways, including embryogenesis, cell proliferation, migration and polarity, apoptosis, and organogenesis. The activation of the WNT/β-catenin pathway is associated with the development of these risk factors.

RECENT FINDINGS

Aortic pulse wave velocity (PWV) is measured to determine AS, and in peripheral artery disease patients, PWV is higher than controls. An augmentation in PWV by 1 m/s has been shown to increase the risk of cardiovascular events by 14%. AS measured by PWV is characterized by the deregulation of the WNT/β-catenin pathway by the inactivation of its two inhibitors, i.e., DKK1 and sclerostin. Thus, this review focuses on the role of the WNT/β-catenin pathway which contributes to the development of arterial stiffness.

Arterial stiffness: A brief review

Apart from the result of multiple diseases as well as aging, arterial stiffness (AS) predicts cardiovascular disease (CVD), especially in patients with chronic kidney disease (CKD). Patients with CKD have high CVD prevalence, and an extraordinarily high risk for CVD might be related to nontraditional risk factors, including AS. The mechanism of AS development could be attributed to oxidative stress, inflammation, uremic milieu (e.g., uremic toxins), vascular calcification, and cumulative effects of traditional cardiovascular risk factors on arteries such as diabetes mellitus or hypertension. There were a variety of non-invasive techniques to measure AS. One of these techniques is carotid–femoral pulse wave velocity, which is the reference measurement of AS and is related to long-term CVD outcomes. AS progression has corresponding medical treatments with modest beneficial results. This review briefly discusses the risk factors, measurements, and treatments associated with AS.

Contribution of Type 2 Diabetes Mellitus to Subclinical Atherosclerosis in Subjects with Morbid Obesity

INTRODUCTION

Type 2 diabetes mellitus (T2DM) and obesity are both related to increased risk of cardiovascular disease and mortality. Early atherosclerotic vascular changes can be detected by non-invasive tests like carotid artery intima-media thickness (cIMT) and pulse wave velocity (PWV). Both cIMT and PWV are significantly impaired in T2DM patients and in obese patients, but the additional effect of T2DM on these vascular measurements in obese subjects has not been evaluated.

METHODS

Two hundred morbidly obese patients with or without T2DM were enrolled in a prospective cohort study and underwent extensive laboratory testing, including cIMT and PWV measurements. The cohort was divided into a group with and a group without T2DM.

RESULTS

Within this cohort, 43 patients (21.5%) were diagnosed with T2DM. These patients were older and had more often (a history of) hypertension as compared to patients without T2DM. HbA1c levels were significantly increased, while LDL cholesterol was significantly lower and the use of statins higher than in non-diabetic participants. cIMT and PWV were significantly increased in subjects suffering from T2DM. The variability in cIMT and PWV was related to differences in age and systolic blood pressure, but not to the presence of T2DM.

CONCLUSION

While T2DM negatively affects the vasculature in morbid obesity, hypertension and age seem to be the major risk factors, independent from the presence of T2DM.

CLINICAL TRIAL REGISTRATION

Dutch Trial Register NTR5172 .

Metabolic Syndrome With Aortic Arterial Stiffness And First Hospitalization Or Mortality In Coronary Artery Disease Patients

PURPOSE

Metabolic syndrome (MetS) and aortic arterial stiffness (AS) are risk factors for future cardiovascular events. We evaluated their roles in first hospitalization or all-cause mortality prediction in coronary artery disease (CAD) patients.

PATIENTS AND METHODS

From January to December 2012, 115 CAD patients were enrolled from a single center and followed up for 5.5 years. The composite endpoint included hospitalization for unstable angina, myocardial infarction, revascularization, or heart failure and all-cause mortality. Patients with carotid-femoral pulse wave velocity > 10 m/s (measured using applanation tonometry) constituted the high AS group.

RESULTS

During a median 54-month follow-up, there were 43 (37.4%) and 11 (9.6%) hospitalization and mortality events, respectively. Overall, 41 (35.7%) and 70 (60.9%) patients were diagnosed with AS and MetS, respectively. CAD patients with high AS had higher diabetes and MetS percentages, were older, and had higher waist circumference and systolic blood pressure (SBP) but lower glomerular filtration rate than those with low AS. Multivariate logistic regression analysis revealed old age (P < 0.001), diabetes (P = 0.003), and high waist circumference (P = 0.044) and SBP (P = 0.007) as independent predictors of AS in CAD patients. Kaplan-Meier analysis showed that CAD patients with concurrent MetS and high AS had a higher risk for hospitalization (log rank test, P = 0.005) or developing all-cause mortality (log rank test, P = 0.002). Compared with CAD patients without MetS or AS, composite outcome development risk in those with both the conditions was 10.2-fold higher (P < 0.001); this risk was 6.54-fold higher in those with AS alone (P = 0.007).

CONCLUSION

In CAD patients, age, diabetes, and high waist circumference and SBP are the independent predictors of AS. Additionally, CAD patients with AS with and without MetS have a high first hospitalization or all-cause mortality development risk.

Gender-specific association of metabolic syndrome and its components with arterial stiffness in the general Chinese population

OBJECTIVES

Metabolic syndrome (MS) is considered to be a cluster of interrelated risk factors for metabolism, which may increase arterial stiffness and cardiovascular morbidity. The cardio-ankle vascular index (CAVI) is a reliable indicator of arterial stiffness and early arteriosclerosis. The main objective of this study is to evaluate the gender-specific relationship between MS and CAVI in the general Chinese population.

METHODS

A total of 1,301 subjects aged 20 to 60 years participated in this study. CAVI was measured noninvasively using a Vasera VS-1000 device. Blood samples and waist circumference were examined to identify metabolic syndrome according to the criteria set forth in the 2009 Joint Scientific Statement.

RESULTS

The prevalence of MS in the study subjects was 17.4% (30.7% in males and 7.0% in females, P < 0.001). CAVI values were significantly higher in MS subjects than in non-MS subjects and increased linearly as the number of MS components increased in females, but not in males. Using multiple regression analysis, we found that BMI was correlated with CAVI in the overall population and in both genders, and that high-density lipoprotein cholesterol (HDL-C) was associated with CAVI in males, while the number of MS components was related to CAVI in females. CAVI values increased linearly with age in both genders (P-trend < 0.001 for both), and this correlation was stronger in males than in females.

CONCLUSIONS

There are gender-specific differences in the association of MS and CAVI. First, the effects of the number of MS components on CAVI are stronger in females than in males. Second, the effect of each MS component on arterial stiffness may differ in relation to gender. In addition, aging affects arterial stiffness more severely in males, and the increase in arterial stiffness tends to occur at a younger age in males than in females. Larger samples and longitudinal studies are needed to further confirm our results in the future.

Association between the Time of Length since Smoking Cessation and Insulin Resistance in Asymptomatic Korean Male Ex-Smokers

AIM

Smoking is a major risk factor for diabetes mellitus, mainly due to decreased insulin secretion and increased insulin resistance. However, there has been little research on the effects of smoking cessation period on changes in insulin resistance. In this study, we investigated the relationships between the length of time since smoking cessation period and insulin resistance in asymptomatic Korean male ex-smokers.

METHODS

A total of 851 male adults were included in this study. We considered several factors that can affect insulin resistance, and through multiple linear regression analysis, we assessed the effect the length of time since smoking cessation on insulin resistance in ex-smokers. Insulin resistance was represented as the insulin resistance index estimated by homeostasis model assessment.

RESULTS

HOMA-IR values showed a statistically significant negative correlation with the length of time since smoking cessation (p = 0.009) in ex-smokers. After performing multiple linear regression analysis using factors that could potentially influence insulin resistance, we found that waist circumference (p = 0.026) and the length of time since smoking cessation (p = 0.039) were independent predictors of HOMA-IR in asymptomatic male ex-smokers.

CONCLUSION

The longer the smoking cessation period, the more the insulin resistance tended to decrease in asymptomatic Korean male ex-smokers.

The relationship between cholesterol concentration and carotid intima media thickness differs according to gender and menopausal status in Korean type 2 diabetic patients

BACKGROUND

We investigated the associations between cardiometabolic factors and carotid intima media thickness (IMT) in Korea type 2 diabetes (T2DM) patients, and assessed the possible difference with respect to gender and menopausal status.

METHODS

We conducted a cross-sectional study with 1288 T2DM patients from the Department of Endocrinology and Metabolism at Gangnam Severance Hospital. Carotid IMT and various biochemical parameters were measured, and the postmenopausal status was assessed.

RESULTS

In partial correlation analysis, total cholesterol (TC) and LDL cholesterol (LDL-C) were positively correlated with right maximum IMT in men. For postmenopausal women, TC and LDL-C were positively correlated with IMT (all p<0.05) while no such correlation was observed in premenopausal women. In regression analysis, age was the most predominant factor for IMT in all 3 groups. For men, insulin and TC were predictive factors for maximum IMT (all p<0.05), and for postmenopausal women, TC and LDL-C were significant factors for mean and maximum IMT (all p<0.01). However, cholesterol concentrations were not related to all types of IMT in premenopausal women.

CONCLUSION

The association between LDL-C and carotid IMT seems to differ according to gender and menopausal status in T2DM patients.

Independent association between glycated hemoglobin and arterial stiffness in healthy men

Aims/Introduction

Materials and Methods

Results

Conclusions

Different Impacts of Cardiovascular Risk Factors on Arterial Stiffness versus Arterial Wall Thickness in Japanese Patients with Type 2 Diabetes Mellitus

AIM

We statistically investigated whether the impact of cardiovascular risk factors on arterial stiffness would be different from that on arterial wall thickness.

METHODS

We analyzed 1648 Japanese type 2 diabetic patients. Arterial stiffness was evaluated by pulse wave verbosity (PWV) and wall thickness was assessed with carotid intima-media thickness (IMT) by ultrasonography. We developed a common regression model to PWV and IMT by extending the linear mixed model and statistically detected the difference in the impact of cardiovascular risk factors between the two indices.

RESULTS

There was a significant correlation between PWV and IMT (r=0.365, p ＜ 0.001). Sex, diabetic duration, hemoglobin A1c levels, and the presence of retinopathy and cardiovascular disease were comparable independent risk factors for elevated PWV and IMT. On the other hand, the impact of age, systolic blood pressure, and low- and high-density lipoprotein cholesterol levels were significantly different between the two measurements (all p ＜ 0.05). Cholesterol levels were significantly associated with IMT but not with PWV. Age and systolic blood pressure had a significant impact on both measurements, but the impact on PWV was significantly greater than that on IMT. Indeed, patients with low IMT but with advanced age and high systolic pressure had high PWV, whereas patients with low PWV but with impaired cholesterol levels had high IMT.

CONCLUSION

The extended linear mixed model statistically confirmed that the impact of cardiovascular risk factors on elevated PWV and IMT were not identical in Japanese patients with type 2 diabetes mellitus.

Association of Metabolic Syndrome with the Cardioankle Vascular Index in Asymptomatic Korean Population

AIM

Metabolic syndrome is characterized by a cluster of atherosclerotic cardiovascular risk factors. The cardioankle vascular index (CAVI) reflects arterial stiffness and may be used as an indicator of atherosclerotic cardiovascular disease. In this study, we investigated the association of CAVI with metabolic syndrome.

METHODS

A total of 1,144 adults were included in this study. We measured CAVIs and examined blood samples to identify metabolic syndrome according to WHO Asia Pacific criteria and NCEP-ATPIII criteria. AST, ALT, r-GTP, BUN, creatinine, high sensitivity C-reactive protein, and uric acid were also measured.

RESULTS

CAVI values were significantly higher in subjects with metabolic syndrome than those without metabolic syndrome and increased according to the number of metabolic syndrome components present. Subjects with high fasting blood sugar levels or high blood pressure showed high CAVI values. Multiple regression analysis showed that age, sex, diastolic blood pressure, and uric acid were independent predictors of CAVI.

CONCLUSION

Subjects with metabolic syndrome had high CAVIs, which indicated arterial stiffness, and were closely associated with an increase in the number of metabolic risk factors. The individual risk factors for metabolic syndrome have the synergistic effect of elevating arterial stiffness in asymptomatic Korean population.

Triiodothyronine level predicts visceral obesity and atherosclerosis in euthyroid, overweight and obese subjects: T3 and visceral obesity

SUMMARY

OBJECTIVE

We assessed how thyroid hormones affect the visceral obesity and atherosclerosis in euthyroid, overweight and obese Asian subjects.

METHODS

Metabolic parameters and thyroid hormone levels were measured in 177 subjects who visited obesity clinic at Gangnam Severance Hospital. Total adipose tissue area (TAT), subcutaneous adipose tissue area (SAT), visceral adipose tissue area (VAT) were quantified by computerized tomography scan, and, pulse wave velocity (PWV) was measured as a marker of atherosclerosis.

RESULTS

T3 was significantly related to all the measures of abdominal fat, TAT (P = 0.001), SAT (P = 0.015), VAT (P < 0.001), and waist circumference (P = 0.001) as well as BMI (P = 0.017) and total body fat percent (P = 0.001) after adjusting for age and sex. In multiple regression analysis, T3 was independently associated with VAT (β = 0.486, P = 0.009). There was a positive correlation between T3 and PWV.

CONCLUSIONS

T3 level is positively associated with the amount of visceral fat and PWV. Visceral obesity seems to cause an increase in circulating T3 level as an adaptational response to increase the energy expenditure, and thus a more close attention and an effort to assess cardiovascular risks should be made to people with high normal T3 level.

Significance of the presence of metabolic syndrome in patients with asymptomatic arteriosclerosis affecting the aorta and the cerebral, extra-cranial carotid and coronary arteries

OBJECTIVE

The presence of metabolic syndrome (MetS) is strongly associated with stroke and cardiovascular diseases. However, the relationship between MetS and the localization of atherosclerosis at various sites remains uncertain. In this study, in order to reveal the relevance of MetS to atherosclerosis at several sites, we investigated the relationships among vascular risk factors, asymptomatic cerebral infarction and atherosclerosis in the aorta and carotid and coronary arteries in adults without overtly symptomatic cerebrovascular or cardiovascular disease.

METHODS

The subjects in this study included 2,759 Japanese participants (1,845 men and 914 women, mean age: 52 years) with no history of stroke or cardiovascular events. The diagnosis of MetS was made based on modifications to criteria obtained from the National Cholesterol Education Program Adult Treatment Panel. In all subjects, the presence of cerebral infarction in the extra-cranial carotid, coronary and aortic arteries was investigated using MRI, B-mode ultrasonography and CT.

RESULTS

Of the 2,759 subjects, 796 (28.9%) fulfilled the criteria for MetS. The presence of MetS increased the odds ratio (OR) to 1.89 (95% confidence interval (CI): 1.35-2.65, p-value <0.0001) for asymptomatic cerebral infarction, 1.70 (95% CI: 1.37-2.10, p-value <0.0001) for carotid arteriosclerosis, 2.07 (95% CI: 1.62-2.27, p-value <0.0001) for coronary calcification and 1.67 (95% CI: 1.33-2.09, p-value<0.0001) for aortic calcification.

CONCLUSION

The presence of MetS was found to be significantly correlated with arteriosclerosis in all regions, including the cerebral small-vessels, extra-cranial carotid arteries, coronary arteries and abdominal aorta. MetS might be a predictor for small and large vessel disease throughout the body.

Circulatory syndrome: an evolution of the metabolic syndrome concept!

The metabolic syndrome has been a useful, though controversial construct in clinical practice as well as a valuable model in order to understand the interactions of diverse cardiovascular risk factors. However the increasing importance of the circulatory system in particular the endothelium, in both connecting and controlling organ function has underlined the limitations of the metabolic syndrome definition. The proposed "Circulatory Syndrome" is an attempt to refine the metabolic syndrome concept by the addition of recently documented markers of cardiovascular disease including renal impairment, microalbuminuria, arterial stiffness, ventricular dysfunction and anaemia to more classic factors including hypertension, dyslipidemia and abnormal glucose metabolism; all of which easily measured in clinical practice. These markers interact with each other as well as with other factors such as aging, obesity, physical inactivity, diet and smoking. The final common pathways of inflammation, oxidative stress and hypercoagulability thereby lead to endothelial damage and eventually cardiovascular disease. Nevertheless, the Circulatory (MARC) Syndrome, like its predecessor the metabolic syndrome, is only a small step toward an understanding of these complex and as yet poorly understood markers of disease.

The severity of coronary atherosclerosis in diabetic and non-diabetic metabolic syndrome patients diagnosed according to different criteria and undergoing elective angiography

Our aim in this study was to evaluate the relationship between metabolic syndrome (MS) as defined by different criteria and the severity of coronary lesions in a sample of diabetic and non-diabetic patients undergoing elective coronary angiography. All patients had blood and urine tests, physical examinations were performed before angiography, and finally they were classified based on three criteria (World Health Organisation-WHO, Adult Treatment Panel-ATP III and International Diabetes Federation-IDF). Eighty-eight patients were diabetic, and 96 patients were non-diabetic. Among all patients, diabetics had significantly higher Gensini scores (P < 0.001). According to WHO criteria (P = 0.005) and IDF criteria (P = 0.015) metabolic syndrome patients had higher Gensini scores, but for ATP III criteria difference was not significant. When we evaluated diabetics and non-diabetics separately, non-diabetic patients with MS had significantly higher scores with WHO definition (P = 0.015) and mildly higher but not significant values with other MS criteria (P = 0.057 for both IDF and ATP III). Neither any one of MS components nor gender revealed significant relationship with coronary disease severity. In our study with a cohort of Turkish patients undergoing elective coronary angiography; we concluded that MS should be taken into consideration, especially in non-diabetic patients.

Progression of carotid artery intima-media thickness during 12 years in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study

OBJECTIVE

This study investigated the long-term effects of intensive diabetic treatment on the progression of atherosclerosis, measured as common carotid artery intima-media thickness (IMT).

RESEARCH DESIGN AND METHODS

A total of 1,116 participants (52% men) in the Epidemiology of Diabetes Interventions and Complications (EDIC) trial, a long-term follow-up of the Diabetes Control and Complications Trial (DCCT), had carotid IMT measurements at EDIC years 1, 6, and 12. Mean age was 46 years, with diabetes duration of 24.5 years at EDIC year 12. Differences in IMT progression between DCCT intensive and conventional treatment groups were examined, controlling for clinical characteristics, IMT reader, and imaging device.

RESULTS

Common carotid IMT progression from EDIC years 1 to 6 was 0.019 mm less in intensive than in conventional (P < 0.0001), and from years 1 to 12 was 0.014 mm less (P = 0.048); but change from years 6 to 12 was similar (intensive - conventional = 0.005 mm, P = 0.379). Mean A1C levels during DCCT and DCCT/EDIC were strongly associated with progression of IMT, explaining most of the differences in IMT progression between DCCT treatment groups. Albuminuria, older age, male sex, smoking, and higher systolic blood pressure were significant predictors of IMT progression.

CONCLUSIONS

Intensive treatment slowed IMT progression for 6 years after the end of DCCT but did not affect IMT progression thereafter (6-12 years). A beneficial effect of prior intensive treatment was still evident 13 years after DCCT ended. These differences were attenuated but not negated after adjusting for blood pressure. These results support the early initiation and continued maintenance of intensive diabetes management in type 1 diabetes to retard atherosclerosis.

Effects of metabolic syndrome on cardio-ankle vascular index in middle-aged and elderly Chinese

Metabolic syndrome is characterized by multiple risk factors and is associated with increased risk of diabetes and cardiovascular disease. The rapid change in the lifestyle and food habits of Chinese people has resulted in metabolic syndrome becoming one of the most widespread health challenges in China. Recently, the cardio-ankle vascular index (CAVI) was developed as a new parameter reflecting arterial stiffness and providing an index of vascular status. The purpose of this study was to investigate the effect of metabolic syndrome on CAVI. A total of 222 Chinese subjects aged 50-92 years participated in this study. We measured CAVI and examined blood samples to define metabolic syndrome according to the International Diabetes Federation criteria. CAVI in the subjects with abnormal waist circumference was significantly higher than that obtained in the normal subjects (P < 0.01). In the abnormal high-density lipoprotein cholesterol (HDL-C) group, CAVI was significantly increased (P < 0.01) compared to the normal HDL-C group. CAVI showed a positive correlation with waist circumference and increased significantly with the number of metabolic syndrome components. In conclusion, subjects with metabolic syndrome have a high CAVI that indicated arterial stiffness and is closely associated with an increase in the number of metabolic syndrome risk factors. Elevated abdominal obesity and low HDL-C are the main players affecting arterial stiffness in the middle-aged and elderly Chinese. These findings suggest that interaction of the individual components of metabolic syndrome plays a role in the relationship between metabolic syndrome and arterial stiffness.

The metabolic syndrome and its traits as risk factors for subclinical atherosclerosis

CONTEXT AND OBJECTIVE

The metabolic syndrome (MetS) indicates an increased cardiovascular risk. The objective of the present study was to determine the impact of the MetS and its individual traits on subclinical atherosclerosis, as measured with six noninvasive measurements of atherosclerosis (NIMA) in a 50- to 70-yr-old Dutch population-based cohort. Furthermore, we determined the impact of three different definitions of the MetS.

DESIGN

We performed NIMA in 1517 participants of the Nijmegen Biomedical Study. The MetS was defined by definitions of the National Cholesterol Education Program, International Diabetes Federation, and the World Health Organization.

RESULTS

Participants with the MetS (National Cholesterol Education Program) were characterized by increased subclinical atherosclerosis compared with participants without any trait of the MetS, as reflected by lower ankle-brachial index at rest [percent change (95% confidence interval), M: -5.2% (-9; -1), F: -3.1% (-6; -1)] and after exercise [M: -7.7% (-17;+2), F: -6.6% (-11; -2)], higher augmentation index [M: +4.8% (+3; +7), F: +1.9% (+4; +18)], increased pulse wave velocity [M: +22.8% (+15;+32), F: +20.5% (+14; +28)], increased intima-media thickness [M: +9.3% (+5; +13), F: +6.9% (+3; +11)], and thicker plaques [M: +17.6% (-2; +41), F: +26.6% (+5; +53)]. Most intriguingly, the number of traits was strongly associated with the severity of subclinical atherosclerosis because all NIMA gradually deteriorated with increasing number of traits present; NIMA were already deteriorated when one or two traits were present and further deteriorated when four or five traits of the MetS were present. Similar result were found when International Diabetes Federation and World Health Organization definitions of the MetS were used.

CONCLUSIONS

For cardiovascular risk prediction, it is more important to take into account the presence of each individual trait and the number of traits of the MetS than to diagnose the presence of the MetS.

In addition to insulin resistance and obesity, brachial-ankle pulse wave velocity is strongly associated with metabolic syndrome in Chinese--a population-based study (Taichung Community Health Study, TCHS)

AIM

To investigate the association between arterial stiffness (present with brachial-ankle pulse wave velocity (baPWV)) and metabolic syndrome (MetS) in a population-based study of middle-aged Chinese.

METHODS

MetS was defined using the AHA/NHLBI criteria. A total of 1,018 subjects aged 40 years and over were recruited in 2004. Homeostasis model assessment was applied to estimate the degree of insulin resistance (HOMA-IR). The baPWV was divided into four groups by quartiles.

RESULTS

The prevalence of MetS and its individual components increased by the increase in baPWV quartiles. After adjusting for age, BMI, HOMA-IR, smoking, alcohol drinking, betel nut chewing, and physical activity status, multiple logistic regression revealed that baPWV groups were significantly associated with MetS. Compared with the lowest baPWV quartile, the adjusted odds ratio of having MetS in baPWV quartile II, III, IV was 2.10 (1.034.28), 4.48 (2.169.26), 10.4 (4.5324.0) in men, and 4.20 (1.4712.0), 14.6 (5.2240.6), 16.3 (5.4848.2) in women, respectively. The prevalence of MetS increased with the increase of age, HOMA-IR, and BMI groups. The optimal cut-off values of baPWV for MetS were 1,539 cm/sec in men and 1,482 cm/sec in women, respectively.

CONCLUSIONS

In addition to insulin resistance and obesity, baPWV was strongly related to MetS in middle-aged Taiwan Chinese. The cut-off value of baPWV for cardiovascular disease differed between genders.

First trimester adipocytokine concentrations and risk of developing gestational diabetes later in pregnancy

OBJECTIVE

Adipocytokines are important regulators of insulin resistance. The aim of this study was to compare maternal adipocytokines in early pregnancy among women diagnosed with and without gestational diabetes (GDM) months later.

DESIGN

A nested case-control study.

PATIENTS

Adiponectin, resistin and interleukin-6 (IL-6) were measured in 59 nulliparous women (30 women with GDM and 29 controls) in plasma obtained in early pregnancy. Patients underwent routine testing for GDM in late pregnancy.

MEASUREMENTS

Adiponectin was measured using radioimmunoassay. Resistin and IL-6 were measured by ELISA. Statistical analysis included Student's t-test, logistic regression and Pearson's correlation.

RESULTS

Groups were not different by baseline descriptors or obstetric outcomes. Mean gestational age at sampling was 9.3 +/- 2.6 weeks. Adiponectin was lower (P < 0.001) in women who later developed GDM compared to controls (4.3 +/- 0.4 vs. 6.9 +/- 0.6 microg/ml). Adiponectin was negatively associated with the development of GDM (P = 0.002; OR: 0.70, 95% CI: 0.56, 0.88) and the association persisted in multivariable analysis controlling for confounders (P = 0.01; OR: 0.69, 95% CI: 0.52, 0.92). Women with first trimester adiponectin concentrations < 25th% were 10 times more likely to be diagnosed with GDM (OR 10.2; 95% CI 1.3, 78.7). Early adiponectin concentrations negatively correlated with BMI (P = 0.01; r = -0.32) and subsequent 50 g glucose challenge (P = 0.03; r =-0.29). Mean resistin and IL-6 concentrations were not different between the two groups.

CONCLUSIONS

Women with GDM have evidence of altered adipocyte function as measured by adiponectin early in pregnancy, months before the clinical diagnosis of GDM is traditionally made.

Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease

Increased arterial stiffness associated with diabetes and the metabolic syndrome may in part explain the increased cardiovascular disease risk observed in these conditions. Arterial stiffness can be estimated by quantifying pulse pressure but is better described by distensibility and compliance coefficients, pulse wave velocity and wave reflection. The most common non-invasive methodologies used to quantify these estimates of arterial stiffness (e.g. ultrasonography and applanation tonometry) are also described. We then review and summarise the current data on the associations between diabetes, the metabolic syndrome and insulin resistance on the one hand and greater arterial stiffness on the other, and identify and discuss some unresolved issues such as differential stiffening of central vs peripheral arterial segments, the impact of sex, and the pathobiology of increased arterial stiffness in diabetes and the metabolic syndrome. Finally, some considerations with regard to treatment options are presented. At present the most powerful therapy available for reducing arterial stiffness is to vigorously treat hypertension using pharmacological agents. New pharmacological strategies to reduce arterial stiffness are likely to be especially relevant to individuals with diabetes.

Neither the presence of metabolic syndrome as defined by the IDF guideline nor an increased waist circumference increased the risk of microvascular or macrovascular complications in Japanese patients with type 2 diabetes

The aim of this study was to evaluate the relationship between the diagnosis of metabolic syndrome (MetS) or its components and the prevalence of microvascular and macrovascular complications in 130 Japanese type 2 diabetic patients. Out of the 130 patients, 58.5% satisfied the criteria of the MetS as defined by the IDF guideline. The results of logistic regression analysis with adjustment for three variables (age, gender and duration of diabetes) revealed that the presence of MetS as defined by the IDF guideline was not independently related to the presence of proliferative retinopathy, proteinuria, neuropathy, or macrovascular disease in the diabetic patients. The waist circumference per se was not associated with diabetic neuropathy, retinopathy, nephropathy, or macrovascular diseases. These results suggest that neither the presence of MetS, as defined by the IDF guideline, nor the waist circumference was associated with the presence of either microvascular or macrovascular complications in Japanese type 2 diabetic patients.

Diabetic neuropathy is closely associated with arterial stiffening and thickness in Type 2 diabetes

AIMS

Interaction of vascular and metabolic factors appears to contribute to the pathogenesis of diabetic neuropathy. The aim of the study was to assess the impact of arterial stiffening and thickness on diabetic neuropathy in Type 2 diabetes.

METHODS

In 294 patients with Type 2 diabetes, neuropathy was assessed by four components: the presence of neuropathic symptoms, the absence of ankle tendon reflexes, perception of vibration scores and heart rate variation. We measured intima-media thickness (IMT) of carotid arteries to assess arterial thickening, and brachial-ankle pulse-wave velocity (PWV) and brachial pulse pressure (PP) which reflect arterial stiffening.

RESULTS

Diabetic neuropathy, defined as > or = two of the four components, was significantly associated with age, duration, glycated haemoglobin (HbA(1c)), systolic blood pressure, diastolic blood pressure, PP, hypertension, retinopathy, urinary albumin excretion rate, nephropathy stages, PWV and IMT. PWV and PP were significantly associated with neuropathy independent of conventional cardiovascular risk factors. Multiple logistic regression analysis revealed that PWV, retinopathy, age, and HbA(1c), were significant independent determinants of neuropathy.

CONCLUSIONS

The present cross-sectional study indicates that markers for vascular wall properties such as PWV, IMT and PP are significantly associated with diabetic neuropathy. PWV and PP are significant determinants of neuropathy independent of conventional cardiovascular risk factors. Multifactorial intervention to inhibit progression of the atherosclerotic process may slow progression of neuropathy.