Relationship of systemic endothelial function and peripheral arterial stiffness with diabetic retinopathy

Lim, Laurence Shen; Ling, Lieng Hsi; Cheung, Chui Ming Gemmy; Ong, Peng Guan; Gong, Lingli; Tai, E. Shyong; Mathur, Ranjana; Wong, Doric; Foulds, Wallace S.; Wong, Tien Yin

doi:10.1136/bjophthalmol-2014-306075

Cited by 19 publications

(17 citation statements)

References 25 publications

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“…Increased arterial wall stiffness is a hallmark for arteriosclerosis across the whole arterial tree, including lower-extremity arteries, in patients with diabetes (25). Previous studies have shown increased arterial stiffness in patients with a high urinary albumin excretion rate and decreased glomerular filtration rate as well as diabetic retinopathy (23,(26)(27)(28)(29)(30). Few studies have prospectively investigated predictors for the development of PAD in patients with type 2 diabetes (8,14,31).…”

Section: Discussionmentioning

confidence: 99%

Microvascular and Macrovascular Disease and Risk for Major Peripheral Arterial Disease in Patients With Type 2 Diabetes

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Microvascular and Macrovascular Disease and Risk for Major Peripheral Arterial Disease in Patients With Type 2 Diabetes

et al. 2016

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“…In these patients, arterial stiffness has also been reported (31) to be independently associated with the severity of cerebral WMLs. On the other hand, in patients with type 2 diabetes, DR has been independently associated with pulse wave velocity, with the severity of DR being associated with a greater peripheral vascular stiffness (32). The stiffening of large arteries such as the aorta may promote more penetration of the pulsatile energy into the microvasculature of the brain, resulting in a smaller lumen and a reduced vasodilatory reserve.…”

Section: Discussionmentioning

confidence: 99%

Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

et al. 2016

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OBJECTIVEWe sought to examine the presence and severity of brain small vessel disease (SVD) in patients with type 2 diabetes and diabetic retinopathy (DR) compared with those without DR. RESEARCH DESIGN AND METHODSWe evaluated 312 patients with type 2 diabetes without previous cardiovascular disease (men 51%; mean age 57 years; age range 40-75 years); 153 patients (49%) had DR. MRI was performed to evaluate the presence and severity (age-related white matter changes scale) of white matter lesions (WMLs) and lacunes, and transcranial Doppler ultrasound was used to measure the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTSThe prevalence of lesions of cerebral SVD (WML and/or lacunes) was higher in patients with DR (40.2% vs. 30.1% without DR, P = 0.04). Age (P < 0.01) and systolic blood pressure (P = 0.02) were associated with the presence of SVD. The severity of SVD was associated with age and the presence of DR (P < 0.01 and P = 0.01, respectively). Patients with DR showed a higher MCA PI compared with those without DR (P < 0.01). Age, systolic and diastolic blood pressure, and retinopathy and its severity were associated with an increased MCA PI (P < 0.01 for all variables). A positive correlation was found between MCA PI values and the presence and severity of SVD (P < 0.01 for both variables). CONCLUSIONSPatients with type 2 diabetes who have DR have an increased burden of cerebral SVD compared with those without DR. Our findings suggest that the brain is a target organ for microangiopathy, similar to other classic target organs, like the retina.Patients with type 2 diabetes mellitus have an increased risk of cardiovascular (CV) morbidity and mortality. The chronic deleterious effects of hyperglycemia are classically separated into microvascular and macrovascular complications. In addition to the classic target organs of microangiopathy, such as the retina or the kidneys, the brain has also been described more recently as a target organ for diabetic microvascular complications (1).Cerebral small vessel disease (SVD) is the term commonly used to describe a syndrome of clinical, cognitive, neuroimaging, and neuropathological findings that

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“…This finding suggests that endothelial function is enhanced in patients with severe intrarenal arteriolosclerosis. Lim et al reported a similar finding that patients with more severe diabetic retinopathy (DR) had enhanced endothelial function . This phenomenon may be interpreted as a lesion in the microvasculature leading to increased peripheral blood flow, as high RHI levels in patients with more severe microvascular disease may not be associated with better endothelial function.…”

Section: Discussionmentioning

confidence: 99%

“…Rosenbaum et al reported, in a study of 1007 patients, that the AIx measured at the radial artery was significantly related to the intima‐media thickness of the carotid artery after adjusting for multiple variables . Lim et al evaluated the relationship between DR and peripheral AIx in 95 patients and found that patients with more severe DR had greater peripheral vascular stiffness . Zahner et al conducted a study of 101 patients with peripheral artery disease (PAD) and found that patients with PAD had a significantly higher central AIx and peripheral AIx than the control group after adjusting for several atherosclerotic risk factors .…”

Section: Discussionmentioning

confidence: 99%

“…28 Lim et al evaluated the relationship between DR and peripheral AIx in 95 patients and found that patients with more severe DR had greater peripheral vascular stiffness. 23 Zahner et al conducted a study of 101 patients with peripheral artery disease (PAD) and found that patients with PAD had a significantly higher central AIx and peripheral AIx than the control group after adjusting for several atherosclerotic risk factors. 26 intrarenal arteriosclerosis, such as the renal Doppler resistive index (RI); what has been found is that the higher the RI is, the more severe the atherosclerosis.…”

Section: Discussionmentioning

confidence: 99%

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Peripheral arterial stiffness is correlated with intrarenal arteriolosclerosis according to biopsies from patients with kidney disease

Yang

Wang

et al. 2019

Nephrology

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Aim To investigate the possible associations between intrarenal arteriolosclerosis as determine by renal biopsy and endothelial function as well as arterial stiffness measured by peripheral arterial tonometry (EndoPAT). Methods This was a cross‐sectional study. Patients who underwent both renal biopsy and EndoPAT were recruited, and intrarenal arteriolosclerosis was graded according to the pathological slice. Endothelial function and arterial stiffness were both measured by EndoPAT and were expressed by the reactive hyperemia index (RHI) and augmentation index (AIx), respectively. AIx@75, representing the AIx standardized to a heart rate of 75 bpm was also determined. Results In total, 113 patients were assessed, the mean age was 51 ± 13, and 68.1% were men. The natural logarithm RHI (LnRHI), AIx and AIx@75 were significantly different among different grades of intrarenal arteriolosclerosis (P = .030, P < .001, P < .001, respectively). In the multivariable adjusted model, for every SD increase in the AIx and AIx@75, the odds of having more severe arteriolosclerosis were 2.506 times (95% confidence interval [CI] 1.464‐4.288, P = .001] and 3.191 times (95% CI 1.780‐5.719, P < .001) higher, respectively, and the association between the LnRHI and intrarenal arteriolosclerosis was nullified (P = .059). The positive values of the AIx and AIx@75 for the diagnosis of severe intrarenal arteriolosclerosis were 0.80 (95% CI 0.73‐0.88, P < .001) and 0.78 (95% CI 0.70‐0.87, P < .001), respectively. Conclusion Subjects with more severe intrarenal arteriolosclerosis have greater peripheral vascular stiffness; AIx and AIx@75 reflected peripheral vascular stiffness could be used to identify patients with severe intrarenal arteriolosclerosis.

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Relationship of systemic endothelial function and peripheral arterial stiffness with diabetic retinopathy

Abstract: Subjects with more severe DR have larger peripheral reactive hyperaemic responses and greater peripheral vascular stiffness. These findings support the link between the microvascular changes of diabetes and macrovascular disease.

Cited by 19 publications

References 25 publications

Microvascular and Macrovascular Disease and Risk for Major Peripheral Arterial Disease in Patients With Type 2 Diabetes

Microvascular and Macrovascular Disease and Risk for Major Peripheral Arterial Disease in Patients With Type 2 Diabetes

Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

Peripheral arterial stiffness is correlated with intrarenal arteriolosclerosis according to biopsies from patients with kidney disease

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