Key result
Peripheral endothelial dysfunction linked to ~10-fold higher MACE risk in diabetic patients with albuminuria.
Why the study?
Evidence was sparse regarding the usefulness of the reactive hyperemia-peripheral arterial tonometry index in predicting future cardiovascular diseases among diabetic patients.
Does peripheral arterial endothelial dysfunction predict future cardiovascular events in asymptomatic type 2 diabetic patients with albuminuria?
Cohort (n=149)
No
Does peripheral arterial endothelial dysfunction predict future cardiovascular events in asymptomatic type 2 diabetic patients with albuminuria?
Effect estimate: HR 10.95 (95% CI 1.00-119.91)
Absolute Event Rate: 10.5% vs 2.3%
p-value: p=0.050
Peripheral arterial endothelial dysfunction, measured noninvasively by reactive hyperemia-peripheral arterial tonometry, is a strong independent predictor of future cardiovascular events and CKD progression in asymptomatic type 2 diabetic patients with albuminuria.
May aid risk stratification in diabetic albuminuria; hypothesis-generating, with prospective validation needed before practice change.
BACKGROUND: Reactive hyperemia-peripheral arterial tonometry (RH-PAT) is a noninvasive and simple test for evaluating the endothelial function. There has been sparse evidence on the usefulness of the RH-PAT index (RHI) in predicting future cardiovascular diseases among diabetic patients. METHODS: Asymptomatic diabetic patients with albuminuria were selected; their medical history and laboratory findings were evaluated every 3 to 4 months, respectively. The primary outcome was a composite of three-point major adverse cardiovascular events (3-point MACE): death from cardiovascular causes, acute coronary events, or nonfatal stroke. On the contrary, secondary outcomes included a composite of 3-point MACE, hospitalization for heart failure, or chronic kidney disease (CKD) progression. RHI was measured using the Endo-PAT2000 at the baseline. RHI < 1.67 was considered to indicate peripheral endothelial dysfunction (PED). RESULTS: In total, 149 subjects were included (mean age, 61.8 ± 9.2 years; duration of diabetes was 12 years). During the follow-up period (median, 49.7 months), of the 149 subjects, primary outcomes were detected in 12 (1 [2.3%] and 11 [10.5%] of those without and with PED, respectively). The presence of PED in baseline measurements significantly increased both primary and secondary outcomes, following adjustment for age, sex, hypertension, glycated hemoglobin, low-density lipoprotein cholesterol, triglyceride, systolic blood pressure, baseline estimated glomerular filtration rate, overt proteinuria, duration of diabetes, premedical history of ischemic events, anti-platelet agents, and smoking history (hazard ratio [HR]: 10.95; 95% confidence interval CI 1.00-119.91 for the primary outcome; HR, 4.12; 95% CI 1.37-12.41 for secondary outcome). In addition, PED could predict secondary outcomes independent of the risk score according to the American College of Cardiology/American Heart Association (HR: 3.24; 95% CI 1.14-9.17). CONCLUSIONS: PED can independently predict future cardiovascular events among diabetic patients with albuminuria.
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Koo et al. (2020) conducted a cohort in Type 2 diabetes with albuminuria (n=149). Peripheral endothelial dysfunction (RHI < 1.67) vs. No peripheral endothelial dysfunction (RHI ≥ 1.67) was evaluated on Composite of 3-point MACE (death from cardiovascular causes, acute coronary events, or nonfatal stroke) (HR 10.95, 95% CI 1.00-119.91, p=0.050). Peripheral endothelial dysfunction (RHI < 1.67) independently predicted a significantly higher risk of 3-point major adverse cardiovascular events (HR 10.95) in diabetic patients with albuminuria.
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