Arterial Stiffness Is Associated With Cardiovascular, Renal, Retinal, and Autonomic Disease in Type 1 Diabetes

作者：Theilade Simone^*; Lajer Maria; Persson Frederik; Joergensen Christel; Rossing Peter

来源：Diabetes Care, 2013, 36(3): 715-721.

DOI：10.2337/dc12-0850

OBJECTIVE-In patients with type 1 diabetes, we investigated the association between arterial stiffness and diabetes complications %26lt;br%26gt;RESEARCH DESIGN AND METHODS-This was a cross-sectional study including 676 Caucasian patients with type 1 diabetes (374 [55%] men, aged 54 +/- 13 years [mean +/- SD]) and 51 nondiabetic controls (28 [55%] men, aged 47 +/- 13 years). Aortic pulse wave velocity (PWV) was measured with SphygmoCor (AtCor Medical, Sydney, Australia) for 635 patients and all 51 controls. %26lt;br%26gt;RESULTS-PWVs (mean +/- SD) in patients and controls were 10.4 +/- 3.4 and 7.6 +/- 1.9 m/s, respectively (P %26lt; 0.001). After multivariate adjustment, PWV correlated with age, diabetes duration, urinary albumin excretion rate, heart rate, and blood pressure (P %26lt; 0.05 for all). ANCOVA was used for comparisons between groups and adjusted for gender, age, estimated glomerular filtration rate, heart rate, HbA(1c), and 24-h mean arterial pressure. PWVs in normoal-buminuric, microalbuminuric, and macroalbuminuric patients were 9.5 +/- 3.2, 11.0 +/- 3.6, and 11.4 +/- 3.0 m/s, respectively (adjusted P %26lt; 0.001). PWV in patients with previous cardiovascular disease, versus patients without, was 12.1 +/- 3.5 vs. 10.0 +/- 3.2 m/s, respectively (adjusted P %26lt; 0.001). PWVs in patients with high (%26gt;= 140/90 mmHg) versus intermediate (130-40/80-89 mmHg) and low (%26lt;130/80 mmHg) blood pressure were 11.8 +/- 3.6, 10.0 +/- 3.0, and 9.8 +/- 3.3 m/s, respectively (adjusted P %26lt; 0.001). Furthermore, PWV increased with increasing degree of retinopathy: 8.0 +/- 2.5 m/s (nil), 10.0 +/- 2.8 m/s (simplex), 12.1 +/- 3.5 m/s (proliferative), and 12.7 +/- 2.4 m/s (blind), respectively (adjusted P %26lt; 0.001). Finally, PWV increased with abnormal heart rate variability: 11.5 +/- 3.3 m/s vs. 10.1 +/- 3.1 m/s (borderline) and 8.1 +/- 2.1 m/s (normal) (adjusted P = 0.027). %26lt;br%26gt;CONCLUSIONS-Arterial stiffness increased with presence and duration of type 1 diabetes. Furthermore, PWV increased with all the investigated diabetes complications (cardiovascular, renal, retinal, and autonomic disease) independently of other risk factors. Diabetes Care 36:715-721,2013

• 出版日期2013-3