Brachial artery reactivity in asymptomatic patients with type 2 diabetes mellitus and microalbuminuria (from the Detection of Ischemia in Asymptomatic Diabetics–Brachial Artery Reactivity study)

• Published in: The American journal of cardiology 2004-08, Vol.94 (3), p.294-299
• Main Authors: Papaioannou, Georgios I, Seip, Richard L, Grey, Neil J, Katten, Deborah, Taylor, Amy, Inzucchi, Silvio E, Young, Lawrence H, Chyun, Deborah A, Davey, Janice A, Wackers, Frans J.Th, Iskandrian, Ami E, Ratner, Robert E, Robinson, Evelyn C, Carolan, Stella, Engel, Samuel, Heller, Gary V
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Albuminuria - complications; Albuminuria - diagnosis; Biological and medical sciences; Brachial Artery - diagnostic imaging; Brachial Artery - physiology; C-Reactive Protein - analysis; Cardiology. Vascular system; Coronary Artery Disease - etiology; Coronary Artery Disease - physiopathology; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetic Angiopathies - complications; Diabetic Angiopathies - diagnostic imaging; Endothelium, Vascular - physiopathology; Female; Heart; Humans; Linear Models; Male; Medical sciences; Middle Aged; Multivariate Analysis; Nephrology. Urinary tract diseases; Prospective Studies; Reference Values; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sex Factors; Ultrasonography, Doppler; Urinary system involvement in other diseases. Miscellaneous; Urinary tract. Prostate gland; Vasoconstriction - physiology; Vasodilation - physiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2004.04.022

Microalbuminuria is a novel atherosclerotic risk factor in patients with type 2 diabetes mellitus (DM) and predicts future cardiovascular events. Endothelial dysfunction and systemic inflammation have been proposed as common links between microalbuminuria and cardiovascular disease. However, no study has assessed the relation between microalbuminuria and vascular dysfunction as measured by brachial artery reactivity (BAR) in DM. We evaluated 143 patients (85 men; mean age 60.0 ± 6.7 years) with DM (mean duration 8.2 ± 7.4 years) enrolled in the Detection of Ischemia in Asymptomatic Diabetics study. Subjects were categorized as those with microalbuminuria (ratio of urinary albumin to creatinine 30 to 299 μg/mg creatinine, n = 28) and those with normoalbuminuria (ratio of urinary albumin to creatinine 0 to 29.9 μg/mg creatinine, n = 115). High-resolution ultrasound BAR testing was used to measure endothelium-dependent and endothelium-independent vasodilations. C-reactive protein was measured as a marker of systemic inflammation. Patients with microalbuminuria and normoalbuminuria had similar baseline characteristics, with the exception that those with microalbuminuria had a longer duration of DM (p = 0.03). Endothelium-dependent vasodilation at 1 minute (p = 0.01) and endothelium-independent vasodilation at 3 minutes (p = 0.007) were significantly less in patients with microalbuminuria. In addition, 96% of patients with microalbuminuria and 76% of those with normoalbuminuria had impaired endothelium-dependent vasodilation (