Arterial stiffness in diabetes and the metabolic syndrome: a pathway to cardiovascular disease

Abstract

Increased arterial stiffness associated with diabetes and the metabolic syndrome may in part explain the increased cardiovascular disease risk observed in these conditions. Arterial stiffness can be estimated by quantifying pulse pressure but is better described by distensibility and compliance coefficients, pulse wave velocity and wave reflection. The most common non-invasive methodologies used to quantify these estimates of arterial stiffness (e.g. ultrasonography and applanation tonometry) are also described. We then review and summarise the current data on the associations between diabetes, the metabolic syndrome and insulin resistance on the one hand and greater arterial stiffness on the other, and identify and discuss some unresolved issues such as differential stiffening of central vs peripheral arterial segments, the impact of sex, and the pathobiology of increased arterial stiffness in diabetes and the metabolic syndrome. Finally, some considerations with regard to treatment options are presented.At present the most powerful therapy available for reducing arterial stiffness is to vigorously treat hypertension using pharmacological agents. New pharmacological strategies to reduce arterial stiffness are likely to be especially relevant to individuals with diabetes.

Impact of metabolic indices on central artery stiffness: independent association of insulin resistance and glucose with aortic pulse wave velocity

“…As has been reported previously, increased cf PWV in latent asymptomatic DM or even earlier in the pathogenesis of insulin resistance is an important pathophysiological finding [41]. Implied central artery stiffening and its attendant vascular consequences clearly develop well before conventionally diagnosed diabetes is manifest.…”

The metabolic syndrome in elderly individuals is associated with greater muscular, but not elastic arterial stiffness, independent of low-grade inflammation, endothelial dysfunction or insulin resistance—The Hoorn Study

“…Thirdly, with regard to the estimates of central stiffness, it is still a matter of debate whether, for example, alterations in augmentation index could occur independently from changes in blood pressure or other measures of stiffness. 3 Future research will clarify this issue. Finally, as stated before, our results could have been influenced by selective mortality, which may have caused us to underestimate the relationship between the MetS and arterial stiffness.…”

“…1,2 How the MetS is associated with an increased CVD risk is incompletely understood, but one pathway linking the MetS to CVD may be through increasing arterial stiffness. 3 The term arterial stiffness refers to an impairment in the cushioning function of the artery (that is, a diminished ability to convert the pulsatile blood flow from the heart into a steady and continuous stream throughout the arterial tree), which leads to increased systolic blood pressure, left ventricular hypertrophy, impaired coronary perfusion and arterial stiffness-associated CVD (notably, stroke, heart failure and myocardial infarction), 4 and can be measured both locally (at a single location within the artery wall) or regionally (over a prespecified arterial segment, for example, the carotid-femoral tract). Earlier studies on arterial stiffness in the MetS [5][6][7][8][9][10][11][12][13][14][15][16] have raised several issues.…”

Predictive markers of abdominal aortic stiffness measured by echo-tracking in subjects with varying insulin sensitivity

“…However, none of previous publications using this method, to our knowledge, have stated objectives similar to our study. There exists strong evidence that diabetes is associated with increased arterial stiffness 5 . Associations have also been described between arterial stiffness and prediabetic states such as insulin resistance and impaired glucose tolerance 6,19,20 .…”

“…Such gender differences have also been shown in type 1 diabetics using echo-tracking system where diabetic women showed higher abdominal aortic stiffness compared to controls 27 . A greater impact of diabetes on arterial stiffness in women could, at least partially, explain the more marked increase in cardiovascular disease risk associated with diabetes in women than in men 5 . In univariate correlation analysis the association between β-coefficient and waist circumference was significant among women but it lost its significance in multiple regression analysis.…”