April 24, 2019
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Increased arterial stiffness raises stroke risk in type 2 diabetes

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Adults with type 2 diabetes who also have stiffer arteries are more likely to experience stroke and vascular mortality than those without such arterial stiffness, according to findings presented in Diabetic Medicine.

“Despite significant advances in both understanding and treatment of type 2 diabetes, people with type 2 diabetes are still at a markedly increased risk of (cardiovascular) mortality and morbidity,” Jan Westerink, MD, PhD, an internist and specialist in the department of vascular medicine at the University Medical Centre Utrecht in the Netherlands, and colleagues wrote. “Part of this increased risk is thought to be explained by increased arterial stiffness, which is more prevalent in people with type 2 diabetes than those without diabetes.”

Westerink and colleagues examined data from 1,910 adults with type 2 diabetes (mean age, 61 years; 30% women) who took part in the Second Manifestations of Arterial Disease (SMART) study at the University Medical Centre Utrecht in the Netherlands. The researchers noted that measures of brachial pulse pressure, ankle-brachial index and carotid artery distension were used to produce measures of arterial stiffness. Participants were followed until March 2015 for an average of 7.5 years, with events of myocardial infarction and stroke as well as vascular and all-cause mortality logged.

During follow-up, 380 participants experienced a CV event, and there were also 436 deaths reported. Raising brachial pulse pressure by 10 mm Hg increased the likelihood of stroke (HR = 1.17; 95% CI, 1.03-1.32), vascular mortality (HR = 1.14; 95% CI, 1.05-1.23) and a CV event (HR = 1.09; 95% CI, 1.02-1.16) as well as all-cause mortality (HR = 1.1; 95% CI, 1.03-1.16). When excluding participants who were prescribed blood pressure medications, the relationships held for vascular mortality (HR = 1.2; 95% CI, 1.06-1.37), CV events (HR = 1.12; 95% CI, 1-1.26) and all-cause mortality (HR = 1.16; 95% CI, 1.06-1.28).

The researchers also observed that when the ankle-brachial index ratio fell by 0.1 points, participants were at increased risk for vascular mortality (HR = 1.24; 95% CI, 1.06-1.46), a CV event (HR = 1.13; 95% CI, 1.01-1.27) and overall mortality (HR = 1.17; 95% CI, 1.04-1.31), but not when excluding those prescribed BP medications. Similarly, the researchers found that participants were at increased risk for stroke (HR = 1.07; 95% CI, 1-1.15), vascular mortality (HR = 1.04; 95% CI, 1-1.09) and overall mortality (HR = 1.04; 95% CI, 1-1.07) when the carotid artery distensibility coefficient fell 1 U, but the significance did not remain when excluding BP medication users. In addition, while the researchers noted associations between all three measures of arterial stiffness and MI, significance was not reached.

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“The present study shows that arterial stiffness can be used as a target factor in intervention research in order to confirm the causality of these findings and to assess the magnitude of cardiovascular risk reduction,” the researchers wrote. “Also, these noninvasive techniques, especially brachial pulse pressure, which can be easily derived from regular blood pressure measurements, can be used in future prognostic research in order to assess their usability in identifying people with type 2 diabetes at higher risk of cardiovascular events and all-cause mortality.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.