Association of Endothelial and Vascular Smooth Muscle Dysfunction with Cardiovascular Risk Factors, Vascular Complications, and Subclinical Carotid Atherosclerosis in Type 2 Diabetic Patients

Naoya Kawano; Masanori Emoto; Katsuhito Mori; Yuko Yamazaki; Hiromi Urata; Shoko Tsuchikura; Koka Motoyama; Tomoaki Morioka; Shinya Fukumoto; Tetsuo Shoji; Hidenori Koyama; Yasuhisa Okuno; Yoshiki Nishizawa; Masaaki Inaba

doi:10.5551/jat.10629

Original Article

Association of Endothelial and Vascular Smooth Muscle Dysfunction with Cardiovascular Risk Factors, Vascular Complications, and Subclinical Carotid Atherosclerosis in Type 2 Diabetic Patients

Naoya Kawano, Masanori Emoto, Katsuhito Mori, Yuko Yamazaki, Hiromi Urata, Shoko Tsuchikura, Koka Motoyama, Tomoaki Morioka, Shinya Fukumoto, Tetsuo Shoji, Hidenori Koyama, Yasuhisa Okuno, Yoshiki Nishizawa, Masaaki Inaba

Author information

Naoya Kawano
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Masanori Emoto
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Katsuhito Mori
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Yuko Yamazaki
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Hiromi Urata
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Shoko Tsuchikura
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Koka Motoyama
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Tomoaki Morioka
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Shinya Fukumoto
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Tetsuo Shoji
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Hidenori Koyama
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Department of Internal Medicine, Division of Endocrinology and Metabolism, Hyogo College of Medicine.
Yasuhisa Okuno
Department of Geriatrics and Vascular Medicine, Osaka City University Graduate School of Medicine.
Yoshiki Nishizawa
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.
Masaaki Inaba
Department of Metabolism, Endocrinology and Molecular Medicine, Osaka City University Graduate School of Medicine.

Keywords: FMD, NMD, IMT, Stiffness parameter β,, CKD stage, Diabetic angiopathy

JOURNAL OPEN ACCESS

2012 Volume 19 Issue 3 Pages 276-284

DOI https://doi.org/10.5551/jat.10629

View "Advance Publication" version (December 6, 2011).

Details

Abstract

Aim: Atherosclerosis and arteriosclerosis are mainly caused by the dysfunction of arterial components, namely, vascular endothelial cells, smooth muscle cells, and the extracellular matrix. Endothelial dysfunction is well established as a predictive surrogate marker of cardiovascular events; however, little is known regarding the clinical implications of vascular smooth muscle dysfunction for cardiovascular disease and microangiopathy. In the present study, we aimed to clarify the association of arterial dysfunction with micro-/macroangiopathy and conventional cardiovascular risk factors in 181 type 2 diabetic patients (T2DM; age±SD, 64±10 years; duration of diabetes, 12±10 years).
Methods: Flow-mediated dilatation (FMD) and nitroglycerin-mediated dilatation (NMD) were assessed to evaluate endothelial dysfunction and vascular smooth muscle dysfunction, respectively, by using a novel ultrasound device, UNEXEF18G (Unex Co. Ltd., Japan).
Results: The FMD and NMD were 6.4±3.9% and 13.4±6.6%, respectively. No significant differences in FMD were noted between T2DM with and without micro- or macroangiopathy; however, NMD in T2DM patients with micro- and macroangiopathy was significantly lower than that in T2DM patients without angiopathy. NMD decreased with the progression of chronic kidney disease (CKD) stage (p= 0.005), but not FMD (p= 0.071). On multiple regression analysis, significant independent contributors to FMD were age, smoking, systolic blood pressure, glycosylated hemoglobin, and serum total cholesterol, while those for NMD were age, systolic blood pressure, and waist circumference.
Conclusion: The relationship of vascular complications and cardiovascular risk factors with NMD is different from that with FMD in type 2 diabetic patients.

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