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Original Research

Central Pulse Pressure and Its Hemodynamic Determinants in Middle-Aged Adults With Impaired Fasting Glucose and Diabetes

The Asklepios study

  1. Julio A. Chirinos, MD, PHD1,2⇑,
  2. Patrick Segers, PHD3,
  3. Thierry C. Gillebert, MD, PHD4,
  4. Marc L. De Buyzere, MSC4,
  5. Caroline M. Van daele, MD4,
  6. Zubair A. Khan, MD1,
  7. Umair Khawar, MD1,
  8. Dirk De Bacquer, PHD5,
  9. Ernst R. Rietzschel, MD, PHD4,5,
  10. on behalf of the Asklepios Investigators
  1. 1University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
  2. 2Philadelphia VA Medical Center, Philadelphia, Pennsylvania
  3. 3Institute Biomedical Technology, Ghent University, Ghent, Belgium
  4. 4Department of Cardiovascular Diseases, Ghent University Hospital, Ghent, Belgium
  5. 5Department of Public Health, Ghent University, Ghent, Belgium
  1. Corresponding author: Julio A. Chirinos, julio.chirinos{at}uphs.upenn.edu.
Diabetes Care 2013 Aug; 36(8): 2359-2365. https://doi.org/10.2337/dc12-1463
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Abstract

OBJECTIVE Pulse pressure (PP), a strong predictor of cardiovascular events in type 2 diabetes, is a composite measure affected by several hemodynamic factors. Little is known about the hemodynamic determinants of central PP in type 2 diabetes or whether abnormalities in central pulsatile hemodynamics are already present in individuals with impaired fasting glucose (IFG). In a population-based study, we aimed to compare central PP and its hemodynamic determinants among adults with normal fasting glucose (n = 1654), IFG (n = 240), and type 2 diabetes (n = 33).

RESEARCH DESIGN AND METHODS We measured carotid pressure, left ventricular outflow, aortic root diameter, carotid artery flow, and distension in order to measure various structural and hemodynamic arterial parameters.

RESULTS IFG was associated with a greater mean arterial pressure (MAP) but was not associated with intrinsic aortic stiffening or abnormal aortic pulsatile indices after adjustment for MAP. After adjustment for age, sex, and MAP, type 2 diabetes was associated with a higher aortic root characteristic impedance (Zc), aortic root elastance-thickness product (Eh), and aortic root pulse wave velocity (but not aortic root diameter), a greater carotid-femoral pulse wave velocity, and lower total arterial compliance and wave reflection magnitude. Carotid size, Zc, distensibility, or Eh did not significantly differ between the groups.

CONCLUSIONS Type 2 diabetes, but not IFG, is associated with greater large artery stiffness, without abnormalities in aortic root diameter or carotid stiffness. Subjects with type 2 diabetes demonstrate a decreased reflection magnitude, which may indicate an increased penetration of pulsatile energy to distal vascular beds.

Footnotes

  • This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc12-1463/-/DC1.

  • Received July 23, 2012.
  • Accepted January 4, 2013.
  • © 2013 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Central Pulse Pressure and Its Hemodynamic Determinants in Middle-Aged Adults With Impaired Fasting Glucose and Diabetes
Julio A. Chirinos, Patrick Segers, Thierry C. Gillebert, Marc L. De Buyzere, Caroline M. Van daele, Zubair A. Khan, Umair Khawar, Dirk De Bacquer, Ernst R. Rietzschel, on behalf of the Asklepios Investigators
Diabetes Care Aug 2013, 36 (8) 2359-2365; DOI: 10.2337/dc12-1463

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Central Pulse Pressure and Its Hemodynamic Determinants in Middle-Aged Adults With Impaired Fasting Glucose and Diabetes
Julio A. Chirinos, Patrick Segers, Thierry C. Gillebert, Marc L. De Buyzere, Caroline M. Van daele, Zubair A. Khan, Umair Khawar, Dirk De Bacquer, Ernst R. Rietzschel, on behalf of the Asklepios Investigators
Diabetes Care Aug 2013, 36 (8) 2359-2365; DOI: 10.2337/dc12-1463
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