Relation Between Glycosylated Hemoglobin (Hemoglobin A1c) and Aortic Stiffness in Patients with Type 2 Diabetes

Abstract

Introduction: Type 2 diabetes mellitus (DM) is a major risk factor for cardiovascular diseases and is responsible for the increase in cardiovascular mortality. Chronic hyperglycemia is related to accelerated atherosclerosis. In this study, we tried to demonstrate the relation between glycosylated hemoglobin (HbA1c) level, which is a marker of long-standing hyperglycemia, and aortic stiffness, which is a marker of cardiovascular disease.

Patients and Methods: In total, 100 patients with type 2 DM were included in this study. Patients were divided into three groups according to the HbA1c level (group 1 HbA1c ≤ 6, group 2 HbA1c between 6 and 7, and group 3 HbA1c ≥ 7).

Results: Significant correlation was found between aortic distensibility and HbA1c level (r= 0.283, p= 0.004). Moreover, aortic distensibility was also correlated with the duration of DM (r= −0.172, p= 0.05) and age (r= -0.27, p= 0.006). Significant correlation was determined between aortic strain and fasting blood glucose level, HbA1c level, and the duration of DM (r= −0.265, p= 0.008; r= 0.279, p= 0.005; and r= −0.14, p= 0.03, respectively).

Conclusion: In this study, we showed that aortic stiffness was increased in patients with type 2 DM who have high blood fasting glucose and HbA1c levels. Our study also showed that the duration of DM was related to aortic stiffness. Echocardiographic non-invasive evaluation of aortic stiffness may be helpful in the estimation of cardiovascular risk in patients with DM.

Keywords

• Aortic stiffness,diabetes mellitus

Tip 2 Diabetes Mellituslu Hastalarda Glikolize Hemoglobin (Hemoglobin A1c) ile Aortik Sertlik Arasındaki İlişki

Abstract

Giriş: Tip 2 diabetes mellitus (DM) kardiyovasküler hastalıklar için major risk faktörüdür ve DM’li hastalar artmış kardiyovasküler mortalite ve morbiditeye sahiplerdir. Kronik hiperglisemi ile ilişkili olan birçok mekanizma bu hızlanmış aterosklerozdan sorumlu tutulmaktadır. Bu çalışmada amaç DM’li hastalarda uzun dönem glisemik kontrolün belirteci olan HbA1c seviyesi ile kardiyovasküler hastalıkların belirteci olan aortik sertlik arasındaki ilişkiyi saptamaktır.

Hastalar ve Yöntem: Çalışmamıza kliniğimize başvuran Tip 2 DM’li 100 hasta alındı. Hastalar HbA1c değerlerine göre üç gruba ayrıldı.

Bulgular: Gruplar arasında açlık kan şekerleri, DM süresi ve oral antidiyabetik ya da insülin kullanımında istatistiksel olarak anlamlı şekilde farklı bulundu. Aortik esneyebilirlik ve HbA1c düzeyi arasında önemli ilişki bulundu (r= 0.283; p= 0.004). Bunun yanı sıra, DM süresi (r= -0.172; p= 0.05) açlık kan şekeri (r=0.292; p= 0.003) ve hasta yaşı ile (r= -0.27; p= 0.006) aortik esneyebilirlik arasında da istatistiksel anlama ulaşan korelasyon tespit edildi. Bunun yanında aortik gerilim ile açlık kan şekeri, HbA1c, DM süresi arasında (sırasıyla; r= -0.265; p= 0.008, r= 0.279; p= 0.005 ve r= -0.14; p= 0.03) anlamlı korelasyon bulundu.

Sonuç: Bu çalışmada, yüksek açlık kan şekeri ve HbA1c düzeyine sahip tip 2 diyabet hastalarında aortik sertliğin arttığını gösterdik. Aynı zamanda çalışmamız diyabetin süresi ile aortik sertliğin ilişkili olduğunu göstermiştir. Ekokardiyografiyle noninvaziv yöntem olarak ölçülen aortik elastisite parametreleri hastalığın erken döneminde kardiyovasküler riski tahmin etmede ve önlemede faydalı olabilir.

Keywords

• Aortik sertlik,diabetes mellitus

References

1. 1. Kannel WB, McGee DL. Diabetes and cardiovascular disease: Framingham Study. JAMA 1979;241:2035-38.
2. 2. Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998:339:229-34.
3. 3. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-86.
4. 4. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405-12.
5. 5. Henry RM, Kostence PJ, Dekker JM, Nijpels G, Heine RJ, Kamp O, et al. Arterial stiffness increases with deteriorating glucose tolerans status: the Horrn Study. Circulation 2003;107:2089-95.
6. 6. Breithaupt-Grögler K, Belz GG. Epidemiology of the arterial stiffness. Pathol Biol (Paris) 1999;47:604-13.
7. 7. Monnier VM, Wishvhanath V, Frank KE, Elmets CA, Dauchot P, Kohn RR. Relation between complications of type 1 diabetes mellitus and collagen –linked fluorescence. N Eng J Med 1986;314:403-8.
8. 8. Salomaa V, Riley W, Kark JD, Nardo C, Folsom AR. Non insulin dependent diabetes mellitus and fasting glucose and insulin concentrations are associated with arterial stiffness index. Circulation 1995;91:1432-43.

9. 9. Singer DE, Nathan DM, Anderson KM, Wilson PW, Evans JC. Association of HbA1c with prevalent cardiovascular disease in the original cohort of Framingham Heart Study. Diabetes 1992;41:202-8.
10. 10. Kuusisto J, Mykkanen L, Pyörälä K, Laakso M. NIDDM and its metabolic control predict coronary heart disease in elderly subjects. Diabetes 1994;43:960-7.
11. 11. The expert committee of the diagnosis and classification of the Diabetes mellitus: Report of the expert committee on the diagnosis and clasification of Diabetes mellitus. Diabetes Care 2005;28:4-36. Laakso M. Tip 2 diyabetin patogenezi. In: Tip 2 Diyabet (ed). Goldstein BJ, Wieland DM, AND, 2003. İstanbul:13-28.
12. 12. Lacombe F, Dart A, Dewar E, Jennings G, Cameron J, Laufer E. Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J 1992;13:1040-5.
13. 13. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors and 12- year cardiovascular mortality foe men screened in the multiple risk factor intervention trial. Diabetes Care 1993:16 :434-44.
14. 14. Waller BF, Pulombo PJ, Lie JT, Roberts WC. Status of the coronary arteries at necropsy in Diabetes mellitus after age 30 years: Analysis of 229 diabetic patients with and without evidence of coronary heart disease and comparison to 183 control subjects. Am J Med 1980; 69:498-506.
15. 15. The Diabetes control and complications trial research group. The effect of intensive treatment of Diabetes on the development and progression of long term complications in insulin dependent Diabetes mellitus. N Eng J Med 1993; 329:977-86.
16. 16. Head J, Fuller JH. International variations in mortality among diabetic patients. Diabetologia 1990; 33:447-81.
17. 17. American Diabetes Associstion. Concensus statement: Role of cardiovasculer risk factors in prevection and treatment of macrovasculer disease in diabetes. Diabetes Care 1993;16:72-8.
18. 18. Arnett DK, Evans GW, Riley WA. Arterial stiffness a new cardiovascular risk factor. Am J Epidemiol 1994;140:669-82.
19. 19. Toutouzas K, Stefanadis C, Tsiamis E, Vlachopoulos C, Tousoulis D, Tsioufis C, et al. Aortic pressure diameter relation in patients with noninsulin dependent diabetes mellitus: new insights. Diabetologia 2000;43:1070-5.
20. 20. Eren M, Gorgulu S, Uslu N, Celik S, Dagdeviren B, Tezel T. Relation between aortic stiffness and left ventricular diastolic function in patients with hypertension, diabetes, or both. Heart 2004;90:37-43.
21. 21. Christensen T, Neubauer B. Arterial wall stiffness in insulin dependent Diabetes mellitus: in vivo study. Acta Radiol 1987;28:207-8.
22. 22. Sen T, Tufekcioglu O, Ozdemir M, Tuncez A, Uygur B, Golbasi Z, et al. New echocardiographic parameter of aortic stiffness and atherosclerosis in patients with coronary artery disease: aortic propagation velocity. J Cardiol 2013;62:236-40.
23. 23. Lehmann ED, Gosling RG, Sonksen PH. Arterial wall compliance in Diabetes. Diabetic Med 1992;2:114-9.
24. 24. Brownlee M, Cerami A, Vlassara H. Advanced glycosylation end products in tissue and biochemical basis of diabetic complications. N Eng J Med 1988;318:1315-21.
25. 25. Lacombe F, Dart A, Dewar E, Jennings G. Cameron J, Laufer E. Arterial elastic properties in man: a comparison of echo-Doppler indices of aortic stiffness. Eur Heart J 1992;13:1040-5.
26. 26. Sobenin IA, Tertov VV, Korschinsky T, Bünting CE, Slavina ES, Dedov II, et al. Modified low-density lipoprotein from diabetic patients causes cholesterol accumulation in human intimal aortic cells. Atherosclerosis 1993;100:41-54.
27. 27. Fiengold KR, Grunfeld C, Pnag M, Doerrler W, Krauss RM. LDL subclass phenotype and triglyceride metabolism in non insulin dependent Diabetes. Arteriosclerosis Throm 1992;12:1496-502.
28. 28. Austin MA, King MC, Vranizan KM, Krauss RM. Atherogenic lipoprotein phenotype: A proposed genetic marker for coronary heart disease risk. Circulation 1990;82:495-506.
29. 29. Avolio AP, Deng FQ, Li WQ, Luo YF, Huang ZD, Xing LF, et al. Effect of aging on arterial distensibility in population with high and low prevalence of hypertension: comparation between urban and rural communities in china. Circulation 1985; 71:202-10.
30. 30. Güray Y, Refiker M, Demirkan B, Güray U, Boyacı A, Korkmaz S. Aortic strain and distensibility in patients with metabolic syndrome. Turk Kardiyol Dern Arş-Arch Turk Soc Cardiol 2010;38:14-9.