Flow Mediated Dilatation Is Reduced with the Progressive Stages of Glomerular Filtration Rate and Albuminuria in Type 2 Diabetic Patients without Coronary Heart Disease

Ito, Hiroyuki; Nakashima, Mina; Meguro, Kentaro; Furukawa, Haruki; Yamashita, Hiroyuki; Takaki, Akifusa; Yukawa, Chizuko; Omoto, Takashi; Shinozaki, Masaru; Nishio, Shinya; Abe, Mariko; Antoku, Shinichi; Mifune, Mizuo; Togane, Michiko

doi:10.1155/2015/728127

Cited by 22 publications

(13 citation statements)

References 44 publications

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“…This involvement pattern suggests that shear stress–related vascular‐protection mechanisms may not be working properly or may be defective in DM. Reports indicating impaired flow‐mediated dilatation in diabetic patients also support this thought . To this end, the protective effect of shear stress on the vessel wall may well be stimulated predominantly by peak shear stress episodes induced by peak hyperemic flow velocities rather than by baseline shear stress.…”

Section: Discussionmentioning

confidence: 85%

“…Reports indicating impaired flow-mediated dilatation in diabetic patients also support this thought. [32][33][34] To this end, the protective effect of shear stress on the vessel wall may well be stimulated predominantly by peak shear stress episodes induced by peak hyperemic flow velocities rather than by baseline shear stress. Accordingly, physical activity covering only %2% of daily routine is known to be enough to generate substantial functional and structural vascular improvements.…”

Section: Discussionmentioning

confidence: 99%

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Bimodal Pattern of Coronary Microvascular Involvement in Diabetes Mellitus

Sezer

Kocaaga

Aslanger

et al. 2016

JAHA

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BackgroundThe contribution of functionally disturbed coronary autoregulation and structurally impaired microvascular vasodilatory function to reduced coronary flow velocity reserve, reflecting impaired coronary microcirculation in diabetes mellitus (DM), has not been clearly elucidated. The objective of this study was to identify the mechanism of coronary microvascular impairment in DM in relation to duration of disease.Methods and ResultsCoronary flow velocities in the anterior descending coronary artery were assessed by transthoracic echocardiography following angiography revealing normal epicardial coronary arteries in 55 diabetic and 47 nondiabetic patients. Average peak flow velocities, coronary flow velocity reserve, and microvascular resistance in baseline and hyperemic conditions (baseline and hyperemic microvascular resistance, respectively) were assessed. Reduced coronary flow velocity reserve in patients with short duration (<10 years) of DM compared with nondiabetic patients was primarily driven by increased baseline average peak flow velocity (26.50±5.6 versus 22.08±4.31, P=0.008) in the presence of decreased baseline microvascular resistance (3.69±0.86 versus 4.34±0.76, P=0.003). In contrast, decreased coronary flow velocity reserve in patients with long‐standing (≥10 years) DM compared with nondiabetic patients was predominantly driven by reduced hyperemic average peak flow velocity (41.57±10.01 versus 53.47±11.8, P<0.001) due to increased hyperemic microvascular resistance (2.13±0.42 versus 1.69±0.39, P<0.001).ConclusionsBoth altered coronary autoregulation and impaired microvascular vasodilatory function contribute to DM‐related coronary microvascular impairment in a time‐dependent manner. DM‐induced early functional microvascular autoregulatory impairment seems to evolve into structural microvascular impairment in the initially overperfused microvascular territory at the later stage of disease.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Bimodal Pattern of Coronary Microvascular Involvement in Diabetes Mellitus

Sezer

Kocaaga

Aslanger

et al. 2016

JAHA

View full text Add to dashboard Cite

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“…The systematic search resulted in the inclusion of 193 from a total of 4641 potential articles (Figure ). From the 193 studies included in the analyses, vascular reactivity was assessed in a total of 26570 patients that were considered healthy (n = 7226), overweight (n = 7605), or those with obesity (n = 1758) or that were diagnosed with metabolic sy...…”

Section: Resultsmentioning

confidence: 99%

The continuums of impairment in vascular reactivity across the spectrum of cardiometabolic health: A systematic review and network meta‐analysis

et al. 2019

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This study aimed to assess, for the first time, the change in vascular reactivity across the full spectrum of cardiometabolic health. Systematic searches were conducted in MEDLINE and EMBASE databases from their inception to March 13, 2017, including studies that assessed basal vascular reactivity in two or more of the following health groups (aged ≥18 years old): healthy, overweight, obesity, impaired glucose tolerance, metabolic syndrome, or type 2 diabetes with or without complications. Direct and indirect comparisons of vascular reactivity were combined using a network meta-analysis. Comparing data from 193 articles (7226 healthy subjects and 19344 patients), the network meta-analyses revealed a progressive impairment in vascular reactivity (flow-mediated dilation data) from the clinical onset of an overweight status (−0.41%, 95% CI, −0.98 to 0.15) through to the development of vascular complications in those with type 2 diabetes (−4.26%, 95% CI, −4.97 to −3.54). Meta-regressions revealed that for every 1 mmol/l increase in fasting blood glucose concentration, flow-mediated dilation decreased by 0.52%. Acknowledging that the time course of disease may vary between patients, this study demonstrates multiple continuums of vascular dysfunction where the severity of impairment in vascular reactivity progressively increases throughout the pathogenesis of obesity and/or insulin resistance, providing information that is important to enhancing the timing and effectiveness of strategies that aim to improve cardiovascular outcomes.

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“…FMD is known to reflect the vasodilation of medium‐sized conduit arteries caused by endothelium‐derived NO. Two cross‐sectional studies among Japanese T2DM patients have reported associations between decreased FMD and albuminuria . In Maastricht study, a T2DM‐enriched population‐based cohort study in Netherlands, endothelial function was measured by different methods, including heat‐induced skin hyperemic response using LDF, flicker light‐induced retinal arteriolar dilation using dynamic vessel analyzer, and skin capillaroscopy .…”

Section: Discussionmentioning

confidence: 99%

“…patients have reported associations between decreased FMD and albuminuria. 16,17 In Maastricht study, a T2DM-enriched populationbased cohort study in Netherlands, endothelial function was measured by different methods, including heat-induced skin hyperemic response using LDF, flicker light-induced retinal arteriolar dilation using dynamic vessel analyzer, and skin capillaroscopy. 18,19 The crosssectional associations between endothelial function and albuminuria have been observed using different methods.…”

Section: Discussionmentioning

confidence: 99%