Carotid stiffness and microalbuminuria in patients with type 2 diabetes
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ORIGINAL PAPER
Carotid stiffness and microalbuminuria in patients with type 2 diabetes Wei-Wei Zhan Æ Yu-Hong Chen Æ Yi-Fei Zhang Æ Ying Zhu Æ Yan-Yan Lin Æ Xin-Ping Ren Æ Xiao-Ying Li Æ Yan-Ping Liu
Received: 2 December 2008 / Accepted: 23 February 2009 / Published online: 15 April 2009 Ó Humana Press 2009
Abstract Microalbuminuria is associated with higher cardiovascular mortality, especially in diabetics. But the direct association between microalbuminuria and vascular wall properties is still not clear. We investigated quantitative carotid stiffness (QCS) index in relation to microalbuminuria in 260 Chinese diabetic patients. In categorical analyses, patients with elevated urinary albumin-to-creatinine ratio (uACR) had higher QCS than those with normal uACR (P \ 0.001). The corresponding values for QCS values were 4.4 and 5.9, respectively. In multiple stepwise regression analyses, QCS was significantly associated with age, uACR, plasma glycosylated hemoglobin A1C (HbA1C), and current smoking (P \ 0.05 for all). In conclusion, carotid stiffness as measured by QCS, a local functional measurement of the arterial wall, is increased in type 2 diabetes with microalbuminuria. Keywords Carotid stiffness Microalbuminuria Type 2 diabetes mellitus
Wei-Wei Zhan and Yu-Hong Chen have contributed equally to this article. W.-W. Zhan Y. Zhu Y.-Y. Lin X.-P. Ren Y.-P. Liu (&) Department of Ultrasonography, Ruijin Hospital, Shanghai Jiaotong University Medical School, 197 Ruijin 2nd Road, Shanghai 200025, People’s Republic of China e-mail: [email protected]
Introduction Atherosclerosis is a major complication of type 2 diabetes mellitus and accounts for up to 60–70% of death in diabetic patients [1–4]. Many researches have demonstrated that microalbuminuria is not only a predictor for the development of diabetic nephropathy [5–7] but also a risk factor for coronary artery disease (CAD) in diabetics and nondiabetics [8, 9]. It is associated with higher cardiovascular mortality, especially in diabetics [8]. Many biochemical parameters that indicate endothelial dysfunction and chronic inflammation such as soluble vascular cell adhesion molecule [10], C-reactive protein [11], and fibrinogen [12] have been shown to be significantly associated with microalbuminuria. These findings may support a hypothesis that microalbuminuria reflects generalized vascular damage [13, 14] which may promote atherosclerosis. However, the direct association between microalbuminuria and vascular wall properties is still not clear. A number of researches studied the relation between microalbuminuria and arterial stiffness in diabetes by measuring pulse wave velocity (PWV), a systemic arterial stiffness parameter [15–18]. But in this study, we used a local arterial stiffness index. With the echo-tracking technique, the stiffness of carotids can be automatically measured, and a quantitative carotid stiffness (QCS) can be generated [19]. We investigated in type 2 diabetic patients QCS in relation to microalbuminuria.
Results Y.-H. Chen Y.
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