Increases in Central Aortic Impedance Precede Alterations in Arterial Stiffness Measures in Type 1 Diabetes

  1. Nancy K. Sweitzer, MD, PHD1,
  2. Mohan Shenoy, MD2,
  3. James H. Stein, MD1,
  4. Sunduz Keles, PHD34,
  5. Mari Palta, PHD35,
  6. Tamara LeCaire, MS5 and
  7. Gary F. Mitchell, MD6
  1. 1Department of Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
  2. 2Department of Cardiology, University of Louisville, Louisville, Kentucky
  3. 3Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
  4. 4Department of Statistics, University of Wisconsin, Madison, Wisconsin
  5. 5Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin
  6. 6Cardiovascular Engineering, Inc., Waltham, Massachusetts
  1. Address correspondence and reprint requests to Nancy K Sweitzer, MD, PhD, 600 Highland Ave., MC 5710, E5/582 CSC, Madison, WI 53792. E-mail: nks{at}medicine.wisc.edu

Abstract

OBJECTIVE—Increased pulse pressure has been associated with increased cardiovascular risk in individuals with diabetes. Changes in central aortic properties can increase central pulse pressure and may adversely affect microvascular perfusion and cardiac performance. This study was performed to define early changes in central arterial properties in a group of young individuals with type 1 diabetes.

RESEARCH AND DESIGN METHODS—Seventeen individuals with type 1 diabetes and their nondiabetic control subjects who were participating in the Cardio-Diab Study had arterial stiffness and pulsatile hemodynamics measured with calibrated tonometry and pulsed Doppler. Aortic characteristic impedance (Zc) was calculated from the ratio of change in carotid pressure and aortic flow in early systole. Pulse wave velocity (PWV) was assessed from tonometry and body surface measurements.

RESULTS—Duration of type 1 diabetes was 15.3 ± 0.7 (mean ± SD) years. In type 1 diabetic subjects, central pulse pressure was elevated (45 ± 11 vs. 36 ± 10 mmHg in control subjects, P = 0.02), as was peripheral pulse pressure (54 ± 13 vs. 43 ± 10 mmHg, P = 0.002). Zc was elevated in type 1 diabetes (179 ± 57 vs. 136 ± 42 dynes × s/cm5 in control subjects, P = 0.004), whereas PWV was not different (5.9 ± 0.9 vs. 5.9 ± 0.7 m/s in type 1 diabetic vs. control subjects, respectively; NS). There was a moderate correlation between Zc and urinary albumin excretion (coefficient 0.39, P = 0.02).

CONCLUSIONS—Zc appears to be increased early in type 1 diabetes, before elevation of PWV and is associated with higher pulse pressure, which may contribute to renal microvascular damage in diabetes.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 8 August 2007. DOI: 10.2337/dc07-0191.

    G.A.F. has received honoraria for serving on the speakers’ bureau and consulting fees from OMRON Healthcare, has received honoraria for serving on an advisory board and consulting fees from Inverness Medical Innovations, and has ownership interest in Cardiovascular Engineering, Inc.

    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. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted July 31, 2007.
    • Received January 30, 2007.
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  1. doi: 10.2337/dc07-0191 Diabetes Care November 2007 vol. 30 no. 11 2886-2891
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