Endothelial dysfunction in type 2 diabetic patients with normal coronary arteries: A digital reactive hyperemia study

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• 作者：Paola Gargiulo¹ ; Caterina Marciano¹ ; Gianluigi Savarese ; Carmen D'Amore ; Stefania Paolillo ; Giovanni Esposito ; Maurizio Santomauro ; Fabio Marsico ; Donatella Ruggiero ; Oriana Scala ; Antonio Marzano ; Milena Cecere ; Laura Casaretti ; Pasquale Perrone Filardi ; ^{fpperron@unina.it}
• 关键词：Endothelial dysfunction ; Coronary artery disease ; Type 2 diabetes mellitus
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：30 April, 2013
• 年：2013
• 卷：165
• 期：1
• 页码：67-71
• 全文大小：242 K

文摘

Background

To assess endothelial function (EF) in type 2 diabetic patients with angiographically normal coronaries compared to diabetic patients with obstructive coronary artery disease (CAD) and to non-diabetic patients, with and without CAD.

Methods

One hundred eighty-three patients undergoing coronary angiography were divided in: group 1 with diabetes mellitus (DM) and CAD (n = 58); group 2 with DM without CAD (n = 58); group 3 with CAD without DM (n = 31) and group 4 without CAD and DM (n = 36). EF was assessed by reactive hyperemia index (RHI) using a fingertip peripheral arterial tonometry and compared to values obtained in 20 healthy volunteers.

Results

RHI was significantly lower in patients with DM compared to patients without DM (1.69 ¡À 0.38 vs 1.84 ¡À 0.44; p = 0.019). RHI was comparable among groups 1, 2 and 3, each value being significantly lower compared to group 4 (2 ¡À 0.44; p < 0.001 vs group 1; p < 0.005 vs group 2; p < 0.002 vs group 3). At multivariate analysis DM and CAD were significant predictors of endothelial dysfunction (ED) (OR = 2.29; p = 0.012; OR = 2.76; p = 0.001, respectively), whereas diabetic patients (n = 116) CAD and glycated haemoglobin (HbA1c) were independent significant predictors of ED (OR = 3.05; p = 0.009; OR = 1.96; p = 0.004, respectively). Diabetic patients with ED (n = 67) had higher levels of HbA1c than diabetic patients with normal endothelial function (7.35 ¡À 0.97 vs 6.87 ¡À 0.90; p = 0.008) and RHI inversely correlated to HbA1c (p = 0.02; r = ? 0.210).

Conclusions

Diabetic patients with and without CAD show significantly impaired peripheral vascular function compared to non-diabetic patients without CAD. ED in diabetic patients without CAD is comparable to that of patients with CAD but without DM. HbA1c is a weak independent predictor of ED.