Key result
Higher DBP and ACR predict increased vascular stiffness, with only ~54% of T2DM patients testing normal.
Why the study?
The study aimed to evaluate early associations between CKD-MBD biomarkers and vascular stiffness in T2DM before the onset of cardiovascular events and chronic renal insufficiency.
Cross-Sectional (n=208)
Diastolic blood pressure and albumin-to-creatinine ratio are modifiable risk factors for arterial stiffness in patients with early type 2 diabetes without overt cardiovascular disease.
May warrant monitoring diastolic BP and ACR in early T2DM; leaves open whether modification alters stiffness or outcomes.
AIM: To evaluate early, before the onset of cardiovascular events and of chronic renal insufficiency, the association between chronic kidney disease (CKD)-mineral bone disorder (MBD) biomarkers and vascular stiffness [Cardio Ankle Vascular Index (CAVI)] in the course of type 2 diabetes (T2DM). METHOD: We evaluated 174 T2DM patients [median age 56 years; male/female (M/F) 100/74] with diabetes duration < 10 years and without decreased estimated glomerular filtration rate (eGFR; ≥60 mL/min/1.73 m2) or macrovascular complications. Thirty-four age-matched healthy subjects [M/F 13/21; age 53.5 (50.0-57.7) years; eGFR 107.5 (97.0-119.7) mL/ min1.73 m2] served as local reference control for CAVI (pathological: ≥8) and the novel CKD-MBD biomarkers. RESULTS: Albumin-to-creatinine ratio (ACR) averaged 8.5 mg/g (5.6-17.2) with 12.6% of the patients showing pathologic values, indicative of incipient diabetic nephropathy. Serum parathyroid hormone, fibroblast growth factor 23, and sclerostin were higher while 1,25-dihydroxyvitamin D and Klotho were lower than a control group. CAVI was normal (<8) in only 54% and correlated positively with age (P < 0.001), hemoglobin 1A1c (P = 0.036), and systolic (P = 0.021) and diastolic blood pressure (DBP) (P = 0.001) and negatively correlated with 25-hydroxyvitamin D (P = 0.046). In multivariate analysis, age, DBP, ACR, and serum Klotho were independent positive predictors of CAVI. CONCLUSION: In the absence of overt cardiovascular disease and of chronic renal insufficiency, CAVI is frequently pathologic in T2DM. DBP and ACR are modifiable risk factors of vascular stiffness in T2DM, thus warranting optimal assessment.
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Leto et al. (2022) conducted a cross-sectional in Type 2 diabetes without cardiovascular disease (n=208). Diastolic blood pressure and albumin-to-creatinine ratio vs. Healthy subjects was evaluated on Normal Cardio Ankle Vascular Index (CAVI <8). Diastolic blood pressure (P=0.001) and albumin-to-creatinine ratio were independent predictors of vascular stiffness, which was normal (CAVI <8) in only 54% of T2DM patients.
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