Arterial Wall Structure and Dynamics in Type 2 Diabetes Mellitus Methodological Aspects and Pathophysiological Findings

Type 2 Diabetes Mellitus (DM), or adult-onset diabetes, is being considered as a new pandemic. Cardiovascular disease is the major cause of morbidity and mortality in type 2 DM, due to arterial structure and functional changes. Assessment of arterial structure and biomechanics, by non-invasive methods and parameters, can be used to detect early alterations related to DM. Three markers of vascular disease may help to a better evaluation of vascular dysfunction in type 2 DM patients: carotid intima – media thickness (IMTc), arterial stiffness, assessed by pulse wave velocity (PWV), and endothelial function, evaluated through the brachial artery flow-mediated dilation (FMD). Among these parameters, IMTc is considered a marker of structural vessel wall properties, and arterial stiffness reflects functional wall properties. Endothelial function represents the arterial way to actively regulate its diameter (smooth muscle-dependent actions) and its visco-elastic properties (wall elasticity and viscosity). IMTc is increased in patients with type 2 DM and other independent risk factors, such as: age, hyperlipidemia and duration of DM. Subjects with DM have shown increased arterial stiffness. Type 2 DM is associated with reductions in FMD (endothelial dysfunction), which has already been reported to be inversely and strongly related to the extent of hyperglycemia. The underlying patho-physiological mechanisms are complex and remain to be fully elucidated. A complete understanding of the association between arterial alterations and early detection, and type 2 DM, may be critical for the primary prevention of DM-related macro-vascular disease. Keywords: Type 2 diabetes mellitus, Cardiovascular diseases, Arterial wall structure, Vascular disease, Endothelial function, cerebro-vascular disease, dyslipidemia, abdominal obesity, fibrinolysis, Aldosterone System, thrombosis, vasoconstriction, IMTc, fibrocellular hypertrophy, dyslipemic population, cushioning effect, adequately high level, systolic upstroke, tonometry, epidemiological studies, beta stiffness index, hysteresis loop, PWV, viscous modulus, hemodynamics, viscoelastic, FMD fluctuates, stereotactic clamp, atherosclerosis, viscoelasticity, DM