Prevalence of subclinical damage of peripheral arteries in patients with type 2 diabetes mellitus and arterial hypertension

Aim

To assess the prevalence of the markers of atherosclerosis and arterial stiffness in patients with treated arterial hypertension and type 2 diabetes mellitus.

Material and methods

We recruited 80 patients with arterial hypertension and type 2 diabetes. Arterial stiffness was evaluated by applanation tonometry. Arterial stiffness gradient was calculated as a ratio between cfPWV/crPWV, and its elevation ≥1 was considered as arterial stiffness mismatch. Subclinical arterial damage was assessed by ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI). ABI <0.9 was considered as a marker of subclinical atherosclerosis and ABI>1.3 as a marker of non-compressible arteries. CAVI >9,0 was interpreted as elevated stiffness.

Results

Increased CAVI (≥9.0) and decreased ABI (<0.9) were found in 48% and 14% of patients, respectively. Vascular age exceeded biological age by 5 to 20 years in 15% of patients. Patients with elevated CAVI were older, had higher vascular age, cfPWV and more prominent loss of arterial stiffness gradient. CAVI correlated with age (r=0.49), vascular age (r=0.90), cfPWV (r=0.36), augmentation pressure (r=0.35), albuminuria (r=-0.40), total cholesterol (r=-0.28), smoking (r=-0.27), arterial stiffness gradient (r=-0.40) and PP amplification (r=-0.33). Age was the only significant predictor of CAVI increase (β=0.75, р=0.006). Abnormal ABI was associated with smoking, more frequent treatment with insulin, a longer duration of diabetes, higher serum creatinine and arterial stiffness gradient. There were no significant predictors of ABI increase.

Conclusion

Increased CAVI is highly prevalent in patients with type 2 diabetes mellitus and arterial hypertension, while impairment of ABI is less frequent. CAVI increase and ABI decrease are associated with arterial stiffness mismatch between aorta and brachial arteries.

Key words

Arterial hypertension, diabetes, stiffness gradient, cardio-ankle brachial index, pulse wave velocity.