Association of subclinical myocardial injury with arterial stiffness in patients with type 2 diabetes mellitus

Abstract

ObjectiveType 2 diabetes mellitus (T2DM) is associated with subclinical myocardial injury although the underlying mechanism is uncertain. We postulated that arterial stiffness, endothelial dysfunction and subclinical atherosclerosis may contribute to subclinical myocardial injury in patients with T2DM.MethodsSerum high-sensitivity troponin I (hs-TNI) an indicator of myocardial injury, was measured in 100 patients with T2DM without clinical evidence of macrovascular disease and 150 age and gender-matched controls. Elevated hs-TnI was defined as follow (derived from the 99th percentile from controls): Male >11.1 ng/L; female >7.6 ng/L. Measures that may contribute to myocardial damage in patients with T2DM, including brachial-ankle pulse wave velocity (ba-PWV), brachial flow mediated dilatation (FMD) and carotid intima media thickness (IMT), were also assessed.ResultsThe serum level of hs-TNI (5.7±9.2 μg/L vs. 3.2±1.9 μg/L, P< 0.01) and the prevalence of elevated hs-TNI (12% vs. 4%, P = 0.02) were significantly higher in patients with T2DM than controls. Patients with T2DM also had significantly worse ba-PWV (17.98±3.91ms-1 vs. 15.70±2.96 ms-1), brachial FMD (2.6±3.5% vs. 5.5±4.2%, P< 0.01) and carotid IMT (0.96±0.20 mm vs. 0.86±0.14 mm, P< 0.01). In patients with T2DM, hs-TNI was positively correlated with systolic blood pressure (r = 0.31, P<0.01), serum creatinine (r = 0.26, P = 0.01) and ba-PWV (r = 0.34, P< 0.01). Importantly, multiple regression revealed that only ba-PWV was independently associated with hs-TNI (β = 0.25, P = 0.04).ConclusionThe results demonstrated an independent association between ba-PWV and hs-TNI in patients with T2DM with no clinical evidence of macrovascular disease. These findings suggest that increased arterial stiffness is closely related to subclinical myocardial injury in patients with T2DM.

Relations of circulating GDF-15, soluble ST2, and troponin-I concentrations with vascular function in the community: The Framingham Heart Study

“…In contrast to our findings, a previous study of community-dwelling individuals in China reported a positive association of circulating hs-TnT with CFPWV, and another Chinese case-control study demonstrated a positive association of CFPWV and hs-TnI in patients with type 2 diabetes. [29, 30] The relation was, however, reported to be present only among people aged ≥60 years in the previous community-based study, which may explain the discrepancy with our study. [29] It is also possible that the temporal discrepancy between vascular and biomarker measures may have lead to our missing a true association.…”

Aortic stiffness is associated with elevated high-sensitivity cardiac troponin T concentrations at a chronic stage after ST-segment elevation myocardial infarction

“…An association between aortic stiffness and hs-troponin levels has been shown previously in the general population, as well as in patients with diabetes [14,15]. These data suggest that aortic stiffness promotes myocardial damage independently of concomitant cardiac diseases.…”

“…Furthermore, hsTnT levels have been linked to an increased risk of cardiovascular disease even in the general population [13]. Recently, PWV was linked to elevated hs-troponin concentrations in a community-dwelling population [14], as well as in patients with type 2 diabetes [15]. Etiologically, early wave reflection caused by high aortic stiffness increases left ventricular systolic pressure and consequently myocardial wall stress [3].…”

High-Sensitivity Cardiac Troponin T and Risk of Hypertension

“…39 It is also worth noting that hs-cTNT could potentially be contributing more directly to the development of hypertension. For example, elevated hs-cTNT has been linked with arterial stiffness in diabetics 40 .…”