Brachial artery reactivity in asymptomatic patients with type 2 diabetes mellitus and microalbuminuria (from the Detection of Ischemia in Asymptomatic Diabetics-Brachial Artery Reactivity study)

Georgios I. Papaioannou, Richard L. Seip, Neil J. Grey, Deborah Katten, Amy Taylor, Silvio E. Inzucchi, Lawrence H. Young, Deborah Chyun, Janice A. Davey, Frans J Th Wackers, Ami E. Iskandrian, Robert E. Ratner, Evelyn C. Robinson, Stella Carolan, Samuel Engel, Gary V. Heller

Research output: Contribution to journalArticle

Abstract

Microalbuminuria is a novel atherosclerotic risk factor in patients with type 2 diabetes mellitus (DM) and predicts future cardiovascular events. Endothelial dysfunction and systemic inflammation have been proposed as common links between microalbuminuria and cardiovascular disease. However, no study has assessed the relation between microalbuminuria and vascular dysfunction as measured by brachial artery reactivity (BAR) in DM. We evaluated 143 patients (85 men; mean age 60.0 ± 6.7 years) with DM (mean duration 8.2 ± 7.4 years) enrolled in the Detection of Ischemia in Asymptomatic Diabetics study. Subjects were categorized as those with microalbuminuria (ratio of urinary albumin to creatinine 30 to 299 μg/mg creatinine, n = 28) and those with normoalbuminuria (ratio of urinary albumin to creatinine 0 to 29.9 μg/mg creatinine, n = 115). High-resolution ultrasound BAR testing was used to measure endothelium-dependent and endothelium-independent vasodilations. C-reactive protein was measured as a marker of systemic inflammation. Patients with microalbuminuria and normoalbuminuria had similar baseline characteristics, with the exception that those with microalbuminuria had a longer duration of DM (p = 0.03). Endothelium-dependent vasodilation at 1 minute (p = 0.01) and endothelium-independent vasodilation at 3 minutes (p = 0.007) were significantly less in patients with microalbuminuria. In addition, 96% of patients with microalbuminuria and 76% of those with normoalbuminuria had impaired endothelium-dependent vasodilation (<8%, p = 0.01). Microalbuminuria was an independent predictor of endothelium-dependent vasodilation in the entire cohort (p = 0.045) and after excluding patients on hormone replacement therapy (p = 0.01). Levels of C-reactive protein were significantly higher in patients with microalbuminuria than in those with normoalbuminuria (p = 0.02). We conclude that in DM the presence of microalbuminuria is associated with impaired endothelium-dependent and endothelium-independent vasodilations of the brachial artery and a higher degree of systemic inflammation. In addition, microalbuminuria is an independent predictor of endothelial dysfunction in asymptomatic patients with DM, especially in the absence of hormone replacement therapy.

Original languageEnglish (US)
Pages (from-to)294-299
Number of pages6
JournalAmerican Journal of Cardiology
Volume94
Issue number3
DOIs
StatePublished - Aug 1 2004

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Brachial Artery
Type 2 Diabetes Mellitus
Endothelium
Ischemia
Vasodilation
Diabetes Mellitus
Creatinine
Hormone Replacement Therapy
Inflammation
C-Reactive Protein
Albumins
Blood Vessels
Cardiovascular Diseases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Brachial artery reactivity in asymptomatic patients with type 2 diabetes mellitus and microalbuminuria (from the Detection of Ischemia in Asymptomatic Diabetics-Brachial Artery Reactivity study). / Papaioannou, Georgios I.; Seip, Richard L.; Grey, Neil J.; Katten, Deborah; Taylor, Amy; Inzucchi, Silvio E.; Young, Lawrence H.; Chyun, Deborah; Davey, Janice A.; Wackers, Frans J Th; Iskandrian, Ami E.; Ratner, Robert E.; Robinson, Evelyn C.; Carolan, Stella; Engel, Samuel; Heller, Gary V.

In: American Journal of Cardiology, Vol. 94, No. 3, 01.08.2004, p. 294-299.

Research output: Contribution to journalArticle

Papaioannou, GI, Seip, RL, Grey, NJ, Katten, D, Taylor, A, Inzucchi, SE, Young, LH, Chyun, D, Davey, JA, Wackers, FJT, Iskandrian, AE, Ratner, RE, Robinson, EC, Carolan, S, Engel, S & Heller, GV 2004, 'Brachial artery reactivity in asymptomatic patients with type 2 diabetes mellitus and microalbuminuria (from the Detection of Ischemia in Asymptomatic Diabetics-Brachial Artery Reactivity study)', American Journal of Cardiology, vol. 94, no. 3, pp. 294-299. https://doi.org/10.1016/j.amjcard.2004.04.022
Papaioannou, Georgios I. ; Seip, Richard L. ; Grey, Neil J. ; Katten, Deborah ; Taylor, Amy ; Inzucchi, Silvio E. ; Young, Lawrence H. ; Chyun, Deborah ; Davey, Janice A. ; Wackers, Frans J Th ; Iskandrian, Ami E. ; Ratner, Robert E. ; Robinson, Evelyn C. ; Carolan, Stella ; Engel, Samuel ; Heller, Gary V. / Brachial artery reactivity in asymptomatic patients with type 2 diabetes mellitus and microalbuminuria (from the Detection of Ischemia in Asymptomatic Diabetics-Brachial Artery Reactivity study). In: American Journal of Cardiology. 2004 ; Vol. 94, No. 3. pp. 294-299.
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AU - Papaioannou, Georgios I.

AU - Seip, Richard L.

AU - Grey, Neil J.

AU - Katten, Deborah

AU - Taylor, Amy

AU - Inzucchi, Silvio E.

AU - Young, Lawrence H.

AU - Chyun, Deborah

AU - Davey, Janice A.

AU - Wackers, Frans J Th

AU - Iskandrian, Ami E.

AU - Ratner, Robert E.

AU - Robinson, Evelyn C.

AU - Carolan, Stella

AU - Engel, Samuel

AU - Heller, Gary V.

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N2 - Microalbuminuria is a novel atherosclerotic risk factor in patients with type 2 diabetes mellitus (DM) and predicts future cardiovascular events. Endothelial dysfunction and systemic inflammation have been proposed as common links between microalbuminuria and cardiovascular disease. However, no study has assessed the relation between microalbuminuria and vascular dysfunction as measured by brachial artery reactivity (BAR) in DM. We evaluated 143 patients (85 men; mean age 60.0 ± 6.7 years) with DM (mean duration 8.2 ± 7.4 years) enrolled in the Detection of Ischemia in Asymptomatic Diabetics study. Subjects were categorized as those with microalbuminuria (ratio of urinary albumin to creatinine 30 to 299 μg/mg creatinine, n = 28) and those with normoalbuminuria (ratio of urinary albumin to creatinine 0 to 29.9 μg/mg creatinine, n = 115). High-resolution ultrasound BAR testing was used to measure endothelium-dependent and endothelium-independent vasodilations. C-reactive protein was measured as a marker of systemic inflammation. Patients with microalbuminuria and normoalbuminuria had similar baseline characteristics, with the exception that those with microalbuminuria had a longer duration of DM (p = 0.03). Endothelium-dependent vasodilation at 1 minute (p = 0.01) and endothelium-independent vasodilation at 3 minutes (p = 0.007) were significantly less in patients with microalbuminuria. In addition, 96% of patients with microalbuminuria and 76% of those with normoalbuminuria had impaired endothelium-dependent vasodilation (<8%, p = 0.01). Microalbuminuria was an independent predictor of endothelium-dependent vasodilation in the entire cohort (p = 0.045) and after excluding patients on hormone replacement therapy (p = 0.01). Levels of C-reactive protein were significantly higher in patients with microalbuminuria than in those with normoalbuminuria (p = 0.02). We conclude that in DM the presence of microalbuminuria is associated with impaired endothelium-dependent and endothelium-independent vasodilations of the brachial artery and a higher degree of systemic inflammation. In addition, microalbuminuria is an independent predictor of endothelial dysfunction in asymptomatic patients with DM, especially in the absence of hormone replacement therapy.

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