Impaired Coronary Endothelium–Dependent Vasodilation Is Associated With Microalbuminuria in Patients With Type 2 Diabetes and Angiographically Normal Coronary Arteries
- Emmanuel Cosson, MD1,
- Isabelle Pham, MD, PHD2,
- Paul Valensi, MD1,
- Jacques Pariès, MD1,
- Jean-Raymond Attali, MD1 and
- Alain Nitenberg, MD2
- 1Department of Endocrinology, Diabetology, and Metabolism, Jean Verdier Hospital, Assistance Publique-Hôpitaux Paris, Bondy, France
- 2Department of Physiology and Functional Investigations, Jean Verdier Hospital, Assistance Publique-Hôpitaux Paris, Bondy, France
- Address correspondence and reprint requests to Emmanuel Cosson, MD, Department of Endocrinology, Diabetology, and Metabolism, Jean Verdier Hospital, Assistance Publique-Hôpitaux Paris, Bondy, France. E-mail: emmanuel.cosson{at}jvr.aphp.fr
Abstract
OBJECTIVE—Microalbuminuria and impaired endothelium-dependent vasodilation are both predictors for cardiac events in patients with type 2 diabetes. The aim of the study was to evaluate whether microalbuminuria correlated with coronary endothelium–dependent vasodilation.
RESEARCH DESIGN AND METHODS—We evaluated 84 patients (47 men, mean age 50.5 ± 5.9 years) with type 2 diabetes for 9.4 ± 3.4 years, without angiographic coronary stenosis and without major cardiovascular risk factors or other confounding factors, for endothelium investigation. Quantitative coronary angiography was used to assess coronary artery response to cold pressor testing, used to assess endothelium-dependent vasodilation, and to isosorbide dinitrate (endothelium-independent vasodilation).
RESULTS—Endothelium-dependent vasodilation differed in the patients with and without microalbuminuria (changes in coronary artery diameter during cold pressor testing: −15.0 ± 1.9% vs. −10.2 ± 1.3%, respectively, P < 0.05) and correlated with urinary albumin excretion rate (r = −0.39, P = 0.003), diastolic blood pressure (r = 0.29, P < 0.01), and left ventricular mass index (r = −0.24, P < 0.05). Independent predictors for endothelium-dependent vasodilation were urinary albumin excretion rate (β −0.04 [95% CI −0.07 to −0.01], P < 0.005) and left ventricular mass index (−0.26 [−0.49 to −0.05], P < 0.05). Endothelium-independent vasodilation was similar in both groups.
CONCLUSIONS—Type 2 diabetic patients with microalbuminuria have a more severely impaired coronary endothelium–dependent vasodilation than those with normoalbuminuria. These data suggest a common pathophysiological process for both coronary vasomotor abnormalities and microalbuminuria.
Footnotes
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A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
The costs of publication of this article were defrayed in part by the payment of page charges. The article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted September 22, 2005.
- Received July 29, 2005.
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