Stiffness and Impaired Blood Flow in Lower-Leg Arteries Are Associated With Severity of Coronary Artery Calcification Among Asymptomatic Type 2 Diabetic Patients

Abstract

OBJECTIVE -To clarify whether stiffness and impaired blood flow in lower-leg arteries are associated with severity of coronary artery calcification among asymptomatic diabetic patients.RESEARCH DESIGN AND METHODS -We enrolled 102 asymptomatic type 2 diabetic patients with no history of cardiovascular complications consecutively admitted to our hospital. Agatston coronary artery calcium (CAC) score, as a marker of coronary artery calcification, was obtained using electron-beam computed tomography. Total flow volume and resistive index, as an index of vascular resistance, at the popliteal artery were evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Brachial-ankle pulsewave velocity (PWV), as an index of distensibility in the lower-extremity arteries, was also measured using an automatic device.RESULTS -When the patients were grouped according to CAC scores of 0 -10 (n ϭ 54), 11-100 (n ϭ 25), and Ͼ100 (n ϭ 23), those with the highest scores, which is considered to show possible coronary artery disease, showed the highest brachial-ankle PWV (P Ͻ 0.001) and resistive index (P Ͻ 0.001) and the lowest total flow volume (P Ͻ 0.001) among the groups. Simple linear regression analyses showed that both brachial-ankle PWV (r ϭ 0.508, P Ͻ 0.001) and resistive index (r ϭ 0.500, P Ͻ 0.001) were positively correlated and total flow volume (r ϭ Ϫ0.528, P Ͻ 0.001) was negatively correlated with the log-transformed CAC score. Receiver operator characteristic curve analyses indicated that 1,800 cm/s for brachial-ankle PWV, 1.03 for resistive index, and 70 ml/min for total flow volume were diagnostic values for identifying patients with the highest scores.CONCLUSIONS -Quantitatively assessed stiffness and impaired blood flow in lower-leg arteries may help identify diabetic patients with possible coronary artery disease. Diabetes Care 27:2409 -2415, 2004A therosclerotic coronary artery disease (CAD) is a major cause of mortality and morbidity among diabetic patients (1). It is desirable to identify subjects with coronary atherosclerosis before the onset of angina pectoris or myocardial infarction. When atherosclerotic plaques are at an advanced stage, calcified deposits in the coronary arteries are found more frequently and in greater amounts (2). A number of studies (3) have documented the usefulness of electron-beam computed tomography (EBCT) for the detection and evaluation of the extent of coronary calcified atherosclerotic lesions in asymptomatic patients before the development of life-threatening cardiac complications. The reliability of EBCT in the detection of calcified deposits in coronary arteries has been confirmed by histomorphometric analysis of dissected coronary vessels from autopsied hearts (4). Moreover, diabetic patients show twofold prevalence of extensive coronary artery calcification compared with nondiabetic subjects as evaluated by EBCT (5). Calcified lesions of arterial walls can be classified as either intimal atherosclerotic calcification or medial arterial calcifica...

Effect of Weight Loss and Nutritional Intervention on Arterial Stiffness in Type 2 Diabetes

“…Stiff arteries do not distend effectively during systole. This loss of elasticity causes adverse hemodynamic effects (7,8). Hypertension is strongly associated with arterial stiffness, and prior intervention studies have shown that treatment of hypertension improves arterial stiffness (21).…”

“…Increased stiffness in the aorta and along the aortic iliac pathways is predictive of CVD events (2)(3)(4)(5)(6), which may be attributable to the adverse effect of arterial stiffness on left ventricular after-load and coronary perfusion (7). Also, arterial stiffness is associated with reduced blood volume delivery to the lower extremities (8).…”

Diabetes and Its Chronic Complications in the She Ethnic Minority Group of China

“…An odds ratio above 1 is regarded as a risk factor, whereas a value below 1 was a protective factor. Based on our investigation, presence of major Minnesota codes findings, baPWV above 1,800 cm/s, 11 and eGFR below 60 mL/min/1.73 m 2 were regarded as cardiovascular risks. All P values of < 0.05 (two-tailed) were considered to be significant.…”

“…Serum uric acid was determined by an autoanalyzer using the phosphotungstate method (normal range < 360 mol/L for women and < 420 mol/L for men). Measurements of c-glutamyltranferase (GGT), alanine aminotransferase (ALT), and aspartate aminotransferase (AST) used a rate assay (Roche Modular p800, Roche Diagnostics, Tokyo, Japan) (normal range: GGT, 11 Diagnosis of hypertension was based on the Seventh Joint National Commission recommendation of systolic blood pressure ‡ 140 mm Hg and/or diastolic blood pressure ‡ 90 mm Hg or having been diagnosed with hypertension or taking antihypertension treatment. The TCSS contains system scores (foot pain, numbness, tingling, weakness, ataxia, and upper limb systems, graded as present = 1 and absent = 0), reflex scores (knee reflexes and ankle reflexes, graded as absent = 2, reduced = 1, and normal = 0), and sensory test scores (pinprick, temperature, light touch, vibration, and position, graded as abnormal = 1 and normal = 0).…”

Low Blood Flow Estimates in Lower-Leg Arteries Predict Cardiovascular Events in Japanese Patients With Type 2 Diabetes With Normal Ankle-Brachial Indexes

“…Although the detection of coronary calcium deposits by electron-beam computed tomography does not indicate the location or severity of atherosclerotic lesions, this imaging procedure can predict angiographically confirmed arterial obstruction at the same location or another site (12), myocardial ischemia revealed by thallium exercise scintigraphy (13), and CVD events in asymptomatic subjects (14). We have reported that total flow volume in lower-leg arteries is associated with severity of coronary artery calcification detected by electron-beam computed tomography in type 2 diabetic patients with normal ABI (15). However, association of abnormal peripheral circulation in lower-leg arteries and the incidence of CVD events among diabetic patients with normal ABI is still unclear.…”