Carotid-Femoral Pulse Wave Velocity Is Associated With Cerebral White Matter Lesions in Type 2 Diabetes

  1. Per L. Poulsen, MD, PHD, DMSCI1
  1. 1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Noerrebrogade, Denmark
  2. 2Section of Magnetic Resonance Imaging, Department of Radiology, Aarhus University Hospital, Skejby, Denmark
  3. 3Department of Public Health, Institute of Biostatistics, Aarhus University, Denmark
  4. 4Medical department, Diagnostic Center, Regional Hospital Silkeborg, Denmark
  5. 5Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
  1. Corresponding author: Esben Laugesen, esben.laugesen{at}ki.au.dk.

Abstract

OBJECTIVE Patients with type 2 diabetes have a high incidence of cardiovascular events including stroke. Increased arterial stiffness (AS) predicts cardiovascular events in the general population. Cerebral white matter lesions (WMLs) are associated with an increased risk of stroke. It is unknown whether AS in patients with type 2 diabetes is associated with WMLs.

RESEARCH DESIGN AND METHODS We examined 89 patients recently diagnosed with type 2 diabetes (<5 years) and 89 sex- and age-matched controls. AS was assessed with carotid-femoral pulse wave velocity (PWV). WMLs were identified using magnetic resonance imaging and graded qualitatively with the Breteler scale (no/slight changes = 0, moderate changes = 1, severe changes = 2) and semiquantitatively.

RESULTS The diabetes population had excellent glycemic control (HbA1c, 6.5% [6.2–6.8]; median [interquartile range {IQR}]) and had, compared with the controls, lower office blood pressure (BP) (127 ± 12/79 ± 8 vs. 132 ± 14/84 ± 10 mmHg) and total cholesterol (4.3[3.9–4.7] vs. 5.6 [5.1–6.4]; mmol/L; median [IQR]), (P < 0.01 for all). Despite this, PWV was higher in the patients with diabetes compared with controls (9.3 ± 2.0 vs. 8.0 ± 1.6 m/s; P < 0.0001). PWV was associated with Breteler score (OR 1.36 [95% CI 1.17–1.58]; P < 0.001) and WML volume (1.32 [1.16–1.51]; P < 0.001) per 1 m/s increase in PWV. These associations remained significant when adjusted for age, sex, diabetes, 24-h mean arterial BP, BMI, heart rate, and use of antihypertensives and statins (Breteler score: 1.28 [1.03–1.60]; P < 0.05 and WML volume: 1.30 [1.06–1.58]; P < 0.05).

CONCLUSION PWV was higher among patients with well-controlled type 2 diabetes compared with controls and was independently associated with WMLs. PWV may represent a clinically relevant parameter in the evaluation of cerebrovascular disease risk in type 2 diabetes.

  • Received May 15, 2012.
  • Accepted August 23, 2012.

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This Article

  1. Diabetes Care
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