Login Register Cart 0
Generic placeholder image

Current Hypertension Reviews

Editor-in-Chief

ISSN (Print): 1573-4021
ISSN (Online): 1875-6506

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Renal Function, Albumin-Creatinine Ratio and Pulse Wave Velocity Predict Silent Coronary Artery Disease and Renal Outcome in Type 2 Diabetic and Prediabetic Subjects

Author(s): Ramiro A. Sanchez*, Maria J. Sanchez and Agustin J. Ramirez

Volume 17, Issue 2, 2021

Published on: 10 December, 2020

Page: [131 - 136] Pages: 6

DOI: 10.2174/1573402116999201210194817

Price: $65

Abstract

Introduction: Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre-diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure.

Aim: To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD.

Methods: We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD.

All type 2 DM patients were under antidiabetic treatment with A1C hemoglobin between 5.5 and 6.5%.

Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, coronary angiography was performed. In addition, PWV, glomerular filtration rate, and ACR were evaluated. Statistics: mean±SEM, and ANOVA among groups.

Results: 48.59% of DM2 and 25.58% of GI patients had silent coronary artery had silent coronary artery disease and higher ACR, PWV and reduced GFR. Higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and <60ml.min (p<0.05) in patients with CAD, suggesting a cardio-renal interaction in DM2.

Conclusion: Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors as in DM2. Diabetic and prediabetics still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease.

Keywords: Type 2 diabetes, coronary heart disease, pulse wave velocity, renal impairment, renal function, albumin-creatinine ratio.

« Previous Next »
Graphical Abstract

[1]
Bertoluci MC, Rocha VZ. Cardiovascular risk assessment in patients with diabetes. Diabetol Metab Syndr 2017; 9: 25.
[http://dx.doi.org/10.1186/s13098-017-0225-1] [PMID: 28435446]
[2]
Asmar RG, Topouchian JA, Benetos A, Sayegh FA, Mourad JJ, Safar ME. Non-invasive evaluation of arterial abnormalities in hypertensive patients. J Hypertens Suppl 1997; 15(2): S99-S107.
[http://dx.doi.org/10.1097/00004872-199715022-00010] [PMID: 9218206]
[3]
Asmar R, Benetos A, Topouchian J, et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension 1995; 26(3): 485-90.
[http://dx.doi.org/10.1161/01.HYP.26.3.485] [PMID: 7649586]
[4]
Cavalcante JL, Lima JAC, Redheuil A, Al-Mallah MH. Aortic stiffness: current understanding and future directions. J Am Coll Cardiol 2011; 57(14): 1511-22.
[http://dx.doi.org/10.1016/j.jacc.2010.12.017] [PMID: 21453829]
[5]
Prenner SB, Chirinos JA. Arterial stiffness in diabetes mellitus. Atherosclerosis 2015; 238(2): 370-9.
[http://dx.doi.org/10.1016/j.atherosclerosis.2014.12.023] [PMID: 25558032]
[6]
Blacher J, Asmar R, Djane S, London GM, Safar ME. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension 1999; 33(5): 1111-7.
[http://dx.doi.org/10.1161/01.HYP.33.5.1111] [PMID: 10334796]
[7]
Williams B, Lacy PS, Thom SM, et al. CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 2006; 113(9): 1213-25.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.105.595496] [PMID: 16476843]
[8]
Lehmann ED, Gosling RG, Sönksen PH. Arterial wall compliance in diabetes. Diabet Med 1992; 9(2): 114-9.
[http://dx.doi.org/10.1111/j.1464-5491.1992.tb01746.x] [PMID: 1563244]
[9]
Wada T, Kodaira K, Fujishiro K, et al. Correlation of ultrasound-measured common carotid artery stiffness with pathological findings. Arterioscler Thromb 1994; 14(3): 479-82.
[http://dx.doi.org/10.1161/01.ATV.14.3.479] [PMID: 8123655]
[10]
London GM, Marchais SJ, Safar ME, et al. Aortic and large artery compliance in end-stage renal failure. Kidney Int 1990; 37(1): 137-42.
[http://dx.doi.org/10.1038/ki.1990.19] [PMID: 2299800]
[11]
Toussaint ND, Lau KK, Strauss BJ, Polkinghorne KR, Kerr PG. Associations between vascular calcification, arterial stiffness and bone mineral density in chronic kidney disease. Nephrol Dial Transplant 2008; 23(2): 586-93.
[http://dx.doi.org/10.1093/ndt/gfm660] [PMID: 17933842]
[12]
Madero M, Peralta C, Katz R, et al. Health ABC Study. Association of arterial rigidity with incident kidney disease and kidney function decline: the Health ABC study. Clin J Am Soc Nephrol 2013; 8(3): 424-33.
[http://dx.doi.org/10.2215/CJN.07900812] [PMID: 23271800]
[13]
Chen SC, Chang JM, Liu WC, et al. Brachial-ankle pulse wave velocity and rate of renal function decline and mortality in chronic kidney disease. Clin J Am Soc Nephrol 2011; 6(4): 724-32.
[http://dx.doi.org/10.2215/CJN.07700910] [PMID: 21454721]
[14]
Hermans MM, Henry R, Dekker JM, et al. Estimated glomerular filtration rate and urinary albumin excretion are independently associated with greater arterial stiffness: the Hoorn Study. J Am Soc Nephrol 2007; 18(6): 1942-52.
[http://dx.doi.org/10.1681/ASN.2006111217] [PMID: 17460143]
[15]
Liu CS, Pi-Sunyer FX, Li CI, et al. Albuminuria is strongly associated with arterial stiffness, especially in diabetic or hypertensive subjects-a population-based study (Taichung Community Health Study, TCHS). Atherosclerosis 2010; 211(1): 315-21.
[http://dx.doi.org/10.1016/j.atherosclerosis.2010.02.015] [PMID: 20226463]
[16]
Ford ML, Tomlinson LA, Chapman TP, Rajkumar C, Holt SG. Aortic stiffness is independently associated with rate of renal function decline in chronic kidney disease stages 3 and 4. Hypertension 2010; 55(5): 1110-5.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.143024] [PMID: 20212269]
[17]
Tomiyama H, Tanaka H, Hashimoto H, et al. Arterial stiffness and declines in individuals with normal renal function/early chronic kidney disease. Atherosclerosis 2010; 212(1): 345-50.
[http://dx.doi.org/10.1016/j.atherosclerosis.2010.05.033] [PMID: 20594557]
[18]
Peralta CA, Jacobs DR Jr, Katz R, et al. Association of pulse pressure, arterial elasticity, and endothelial function with kidney function decline among adults with estimated GFR >60 mL/min/1.73 m(2): the Multi-Ethnic Study of Atherosclerosis (MESA). Am J Kidney Dis 2012; 59(1): 41-9.
[http://dx.doi.org/10.1053/j.ajkd.2011.08.015] [PMID: 22000727]
[19]
Wang MC, Tsai WC, Chen JY, Huang JJ. Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease. Am J Kidney Dis 2005; 45(3): 494-501.
[http://dx.doi.org/10.1053/j.ajkd.2004.11.011] [PMID: 15754271]
[20]
Townsend RR, Wimmer NJ, Chirinos JA, Parsa A, Weir M, Peruma LK. Aortic PWV in chronic kidney disease: a CRIC ancillary study Am J Hypertens 2010; 23(3): 282-9.
[http://dx.doi.org/10.1038/ajh.2009.240]
[21]
Schram MT, Henry RMA, van Dijk RAJM, et al. Increased central artery stiffness in impaired glucose metabolism and type 2 diabetes: the Hoorn Study. Hypertension 2004; 43(2): 176-81.
[http://dx.doi.org/10.1161/01.HYP.0000111829.46090.92] [PMID: 14698999]
[22]
Mohan V. Macrovascular component of diabetes atherosclerosis and insulin (CUPS-18). J Assoc Physicians India 2007; 55(Suppl.): 13-8.
[PMID: 17927006]
[23]
Ahmadi N, Nabavi V, Hajsadeghi F, et al. Impaired aortic distensibility measured by computed tomography is associated with the severity of coronary artery disease. Int J Cardiovasc Imaging 2011; 27(3): 459-69.
[PMID: 20711815]
[24]
Lee JM, Shirodaria C, Jackson CE, et al. Multi-modal magnetic resonance imaging quantifies atherosclerosis and vascular dysfunction in patients with type 2 diabetes mellitus. Diab Vasc Dis Res 2007; 4(1): 44-8.
[http://dx.doi.org/10.3132/dvdr.2007.005] [PMID: 17469043]
[25]
van der Meer RW, Diamant M, Westenberg JJ, et al. Magnetic resonance assessment of aortic pulse wave velocity, aortic distensibility, and cardiac function in uncomplicated type 2 diabetes mellitus. J Cardiovasc Magn Reson 2007; 9(4): 645-51.
[http://dx.doi.org/10.1080/10976640601093703] [PMID: 17578719]
[26]
Anna KPoon, Michelle L, Meyer Hirofumi Tanaka, et al. Association of insulin resistance, from mid-life to late-life, with aortic stiffness in late-life: the Atherosclerosis Risk in Communities Study. Cardiovasc Diabetol 2020; 19: 11.
[http://dx.doi.org/10.1186/s12933-020-0986-y]
[27]
Gajdova J, Karasek D, Goldmannova D, et al. Pulse wave analysis and diabetes mellitus A systematic review. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161: 223-33.
[http://dx.doi.org/10.5507/bp.2017.028] [PMID: 28627523]
[28]
Stacey RB, Bertoni AG, Eng J, Bluemke DA, Hundley WG, Herrington D. Modification of the effect of glycemic status on aortic distensibility by age in the multi-ethnic study of atherosclerosis. Hypertension 2010; 55(1): 26-32.
[http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.134031] [PMID: 19933927]
[29]
Cruickshank K, Riste L, Anderson SG, Wright JS, Dunn G, Gosling RG. Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002; 106(16): 2085-90.
[http://dx.doi.org/10.1161/01.CIR.0000033824.02722.F7] [PMID: 12379578]
[30]
Safar ME, London GM, Plante GE. Arterial stiffness and kidney function. Hypertension 2004; 43(2): 163-8.
[http://dx.doi.org/10.1161/01.HYP.0000114571.75762.b0] [PMID: 14732732]
[31]
Doyle A, Mark PB, Johnston N, et al. Aortic stiffness and diastolic flow abnormalities in end-stage renal disease assessed by magnetic resonance imaging. Nephron Clin Pract 2008; 109(1): c1-8.
[http://dx.doi.org/10.1159/000130170] [PMID: 18463420]
[32]
Cândido JSA, Camelo LV, Mill JG, et al. Greater aortic stiffness is associated with renal dysfunction in participants of the ELSA-Brasil cohort with and without hypertension and diabetes. PLoS One 2019; 14(2): e0210522.
[http://dx.doi.org/10.1371/journal.pone.0210522] [PMID: 30716076]
[33]
Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM. Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999; 99(18): 2434-9.
[http://dx.doi.org/10.1161/01.CIR.99.18.2434] [PMID: 10318666]
[34]
Younis A, Goldkorn R, Goldenberg I, et al. Impaired fasting glucose is the major determinant of the 20-year mortality risk associated with metabolic syndrome in nondiabetic patients with stable coronary artery disease. J Am Heart Assoc 2017; 6(11): e006609.
[http://dx.doi.org/10.1161/JAHA.117.006609] [PMID: 29079562]
[35]
Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes Care 2001; 24(4): 683-9.
[http://dx.doi.org/10.2337/diacare.24.4.683] [PMID: 11315831]
[36]
Malik S, Wong ND, Franklin SS, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation 2004; 110(10): 1245-50.
[http://dx.doi.org/10.1161/01.CIR.0000140677.20606.0E] [PMID: 15326067]
[37]
Omboni S, Posokhov I, Parati G, et al. Variable association of 24-h peripheral and central hemodynamics and stiffness with hypertension-mediated organ damage: The VASOTENS Registry. J Hypertens 2020; 38(4): 701-15.
[http://dx.doi.org/10.1097/HJH] [PMID: 31834122]
[38]
Giovacchini G, Cappagli M, Carro S, et al. Microalbuminuria predicts silent myocardial ischaemia in type 2 diabetes patients. Eur J Nucl Med Mol Imaging 2013; 40(4): 548-57.
[http://dx.doi.org/10.1007/s00259-012-2323-5] [PMID: 23314258]
[39]
Emami T, Naeimei Z, Salehifard A, et al. Significance of microalbuminuria in predicting silent myocardial ischemia in patients with type 2 diabetes using myocardial perfusion imaging. Mol Imaging Radionucl Ther 2019; 28(2): 62-8.
[http://dx.doi.org/10.4274/mirt.galenos.2019.93798] [PMID: 31237136]
[40]
Sanchez RA, Ayala M, Baglivo H, et al. Latin America Expert Group; Latin American Expert Group. Latin American guidelines on hypertension. J Hypertens 2009; 27(5): 905-22.
[http://dx.doi.org/10.1097/HJH.0b013e32832aa6d2] [PMID: 19349909]
[41]
Mancia G, De Backer G, Dominiczak A, et al. Management of Arterial Hypertension of the European Society of Hypertension; European Society of Cardiology. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2007; 25(6): 1105-87.
[http://dx.doi.org/10.1097/HJH.0b013e3281fc975a] [PMID: 17563527]

Rights & Permissions Print Cite
Article Metrics
19
1
© 2024 Bentham Science Publishers | Privacy Policy