Carotid arterial remodeling - A maladaptive phenomenon in type 2 diabetes but not in impaired glucose metabolism: The Hoorn Study
Carotid arterial remodeling - A maladaptive phenomenon in type 2 diabetes but not in impaired glucose metabolism: The Hoorn Study
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DOI：
10.1161/01.str.0000115752.58601.0b
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发表时间：
2004-03-01
期刊：
影响因子：
8.3
通讯作者：
Stehouwer, CDA
中科院分区：
文献类型：
--
作者：
Henry, RMA;Kostense, PJ;Stehouwer, CDA
背景和目的--葡萄糖耐量下降与心血管疾病风险增加有关.其潜在机制尚不清楚。动脉重塑是响应于致动脉粥样硬化和/或血液动力学改变的结构特性随时间的变化，目的是保持周向壁应力恒定（σ（C））。动脉重塑尚未研究葡萄糖tolerance.Methods -研究人群包括278人正常糖代谢，168与糖代谢受损，和301与2型糖尿病（DM-2），他们的平均年龄为67.8岁。我们评估了颈动脉内膜中层厚度（IMT）、室间隔直径（IAD）、管腔直径（LD）和σ（C）。结果-在校正年龄、性别、身高、体重指数和既往CVD后，DM-2与增加的IAD、IMT和σ（C）相关，但与LD无关（回归系数：0.24 mm; 95%置信区间[CI]，0.07至0.41; 0.050 mm; 95% CI，0.024至0.077; 5.00 kPa; 95% CI，0.92至9.08;和0.13 mm; 95%CI，分别为-0.03至0.29）。在进一步调整脉压后，DM-2与IAD之间的相关性消失，而与IMT之间的相关性仍然存在。调整后，糖代谢异常与LD无明显相关性（0.12 mm; 95% CI，-0.06至0.33），sigma（C）（0.25 kPa; 95% CI，-4.49至4.98）、IAD（0.08 mm; 95% CI，-0.11至0.27）或IMT（0.029 mm; 95% CI，-0.002至0.060）。然而，IMT的回归系数是DM-2的一半。结论- DM-2与在IMT增加的情况下保持LD相关，然而，这并不能使增加的sigma（C）标准化。相比之下，葡萄糖代谢受损与LD或IAD的变化无关，而IMT适度增加，但sigma（C）保持不变。因此，DM-2的颈动脉重塑似乎是不适应的，这可能解释了DM-2中CVD风险增加，特别是卒中。
Background and Purpose - Deteriorating glucose tolerance is associated with an increased cardiovascular disease (CVD) risk. The underlying mechanisms remain unclear. Arterial remodeling is the change in structural properties through time in response to atherogenic and/or hemodynamic alterations and aims to maintain circumferential wall stress constant (sigma(C)). Arterial remodeling has not been studied in relation to glucose tolerance.Methods - The study population consisted of 278 people with normal glucose metabolism, 168 with impaired glucose metabolism, and 301 with type 2 diabetes (DM-2); their mean age was 67.8 years. We assessed carotid intima-media thickness (IMT), interadventitial diameter (IAD), lumen diameter (LD), and sigma(C).Results - After adjustment for age, sex, height, body mass index, and prior CVD, DM-2 was associated with increased IAD, IMT, and sigma(C) but not LD ( regression coefficients: 0.24 mm; 95% confidence interval [CI], 0.07 to 0.41; 0.050 mm; 95% CI, 0.024 to 0.077; 5.00 kPa; 95% CI, 0.92 to 9.08; and 0.13 mm; 95% CI, - 0.03 to 0.29, respectively). After additional adjustment for pulse pressure, the association between DM-2 and IAD disappeared, whereas the association with IMT remained. After adjustment, impaired glucose metabolism was not significantly associated with LD (0.12 mm; 95% CI, - 0.06 to 0.33), sigma(C) (0.25 kPa; 95% CI, - 4.49 to 4.98), IAD (0.08 mm; 95% CI, - 0.11 to 0.27), or IMT (0.029 mm; 95% CI, - 0.002 to 0.060). However, the IMT regression coefficient was half that of DM-2.Conclusions - DM-2 is associated with preserved LD at increased IMT, which, however, does not normalize the increased sigma(C). In contrast, impaired glucose metabolism is not associated with changes in LD or IAD, whereas IMT is moderately increased but sigma(C) remains constant. Carotid remodeling in DM-2 thus appears maladaptive, which may explain the increased CVD risk, especially stroke, in DM-2.