Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical interaction between diabetes duration and aortic stiffness in type 2 diabetes mellitus

Journal of Human Hypertension volume 31, pages 189–194 (2017)Cite this article

Subjects

Abstract

Diabetes complications increase with disease duration. No study was performed on the relationship between aortic stiffness and diabetes duration, taking into account the respective influence of such factors on macro- and microcirculation. In total, 618 subjects with type 2 diabetes (259 men) attending the Department of Internal Medicine of Tizi Ouzou Hospital (Algeria) were studied in collaboration with Hotel-Dieu Hospital (Paris, France). Brachial blood pressure (BP), anthropometric, clinical and biological data were evaluated. Aortic stiffness was estimated by carotid-femoral pulse wave velocity (PWV). From lower to higher tertile of diabetes duration, age, BP and PWV (10.1±2.7 to 12.3±2.8 m s−1) increased, while diabetes control and renal function worsened (all P<0.01). Diabetes duration was independently associated with PWV (R2=0.035, P<0.0001), even after adjustment for age, BP, heart rate, cardiovascular events and metabolic syndrome. Diabetes duration was significantly correlated to the prevalence of microalbuminuria (OR (95% CL) 1.3 (1.06–1.63), P=0.01), independently of age, sex, BP and renal function. Increased aortic stiffness was independently associated with the prevalence of cardiovascular events (P<0.001), reaching its maximal value above the first 2 years of diabetes duration. In conclusion, diabetes duration is an independent determinant of aortic stiffness in subjects with type 2 diabetes, representing about 4% of PWV variability. Diabetes duration is associated with microvascular complications independently of renal function, and with macrovascular complications through the presence of increased aortic stiffness.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Eckel RH . Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group II: pathogenesis of atherosclerosis in diabetes. Circulation 2002; 105 (18): e138–e143.

    Article  Google Scholar 

  2. Aoun S, Blacher J, Safar ME, Mourad JJ . Diabetes mellitus and renal failure: effects on large artery stiffness. J Hum Hypertens 2001; 15 (10): 693–700.

    Article  CAS  Google Scholar 

  3. Lacy PS, O’Brien DG, Stanley AG, Dewar MM, Swales PPR, Williams B . Increased pulse wave velocity is not associated with elevated augmentation index in patients with diabetes. J Hypertens 2004; 22 (10): 1937–1944.

    Article  CAS  Google Scholar 

  4. Agnoletti D, Lieber A, Zhang Y, Protogerou AD, Borghi C, Blacher J et al. Central hemodynamic modifications in diabetes mellitus. Atherosclerosis 2013; 230 (2): 315–321.

    Article  CAS  Google Scholar 

  5. Fox CS, Sullivan L, D’Agostino RB, Wilson PWF . The significant effect of diabetes duration on coronary heart disease mortality: the Framingham Heart Study. Diabetes Care 2004; 27 (3): 704–708.

    Article  Google Scholar 

  6. Natarajan S, Liao Y, Sinha D, Cao G, McGee DL, Lipsitz SR . Sex differences in the effect of diabetes duration on coronary heart disease mortality. Arch Intern Med 2005; 165 (4): 430–435.

    Article  Google Scholar 

  7. Wannamethee SG, Shaper AG, Whincup PH, Lennon L, Sattar N . Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men. Arch Intern Med 2011; 171 (5): 404–410.

    Article  CAS  Google Scholar 

  8. Brun E, Nelson RG, Bennett PH, Imperatore G, Zoppini G, Verlato G et al. Diabetes duration and cause-specific mortality in the Verona Diabetes Study. Diabetes Care 2000; 23 (8): 1119–1123.

    Article  CAS  Google Scholar 

  9. Kim Y, Shin M-S, Kim YS, Kang WC, Kim BR, Moon J et al. The impact of diabetes duration on left ventricular diastolic function and cardiovascular disease. Postgrad Med J 2012; 88 (1038): 189–193.

    Article  Google Scholar 

  10. Mitchell GF, Hwang S-J, Vasan RS, Larson MG, Pencina MJ, Hamburg NM et al. Arterial stiffness and cardiovascular events the Framingham Heart Study. Circulation 2010; 121 (4): 505–511.

    Article  Google Scholar 

  11. Van Dijk RAJM, Bakker SJL, Scheffer PG, Heine RJ, Stehouwer CDA . Associations of metabolic variables with arterial stiffness in type 2 diabetes mellitus: focus on insulin sensitivity and postprandial triglyceridaemia. Eur J Clin Invest 2003; 33 (4): 307–315.

    Article  CAS  Google Scholar 

  12. Wadwa RP, Urbina EM, Anderson AM, Hamman RF, Dolan LM, Rodriguez BL et al. Measures of arterial stiffness in youth with type 1 and type 2 diabetes: the SEARCH for diabetes in youth study. Diabetes Care 2010; 33 (4): 881–886.

    Article  Google Scholar 

  13. Cardoso CRL, Ferreira MT, Leite NC, Barros PN, Conte PH, Salles GF . Microvascular degenerative complications are associated with increased aortic stiffness in type 2 diabetic patients. Atherosclerosis 2009; 205 (2): 472–476.

    Article  CAS  Google Scholar 

  14. Charvat J, Chlumsky J, Zakovicova E, Kvapil M . Common carotid artery intima-media thickness is not increased but distensibility is reduced in normotensive patients with type 2 diabetes compared with control subjects. J Int Med Res 2010; 38 (3): 860–869.

    Article  CAS  Google Scholar 

  15. Lee J-I, Oh S-J, Ha W-C, Kwon H-S, Sohn T-S, Son H-S et al. Serum 25-hydroxyvitamin D concentration and arterial stiffness among type 2 diabetes. Diabetes Res Clin Pract 2012; 95 (1): 42–47.

    Article  CAS  Google Scholar 

  16. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report Circulation 2002; 106 (25): 3143–3421.

    Article  Google Scholar 

  17. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D . A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130 (6): 461–470.

    Article  CAS  Google Scholar 

  18. Asmar R, Benetos A, Topouchian J, Laurent P, Pannier B, Brisac AM et al. Assessment of arterial distensibility by automatic pulse wave velocity measurement. Validation and clinical application studies. Hypertension 1995; 26 (3): 485–490.

    Article  CAS  Google Scholar 

  19. Volpe M, Battistoni A, Tocci G, Rosei EA, Catapano AL, Coppo R et al. Cardiovascular risk assessment beyond systemic coronary risk estimation: a role for organ damage markers. J Hypertens 2012; 30 (6): 1056–1064.

    Article  CAS  Google Scholar 

  20. Verbeke F, Lindley E, Van Bortel L, Vanholder R, London G, Cochat P et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for the management of blood pressure in non-dialysis-dependent chronic kidney disease: an endorsement with some caveats for real-life application. Nephrol Dial Transplant 2014; 29 (3): 490–496.

    Article  Google Scholar 

  21. Salah Mansour A, Yannoutsos A, Majahalme N, Agnoletti D, Safar ME, Ouerdane S et al. Aortic stiffness and cardiovascular risk in type 2 diabetes. J Hypertens 2013; 31 (8): 1584–1592.

    Article  Google Scholar 

  22. Cruickshank K . Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function? Circulation 2002; 106 (16): 2085–2090.

    Article  Google Scholar 

  23. Naka KK, Papathanassiou K, Bechlioulis A, Kazakos N, Pappas K, Tigas S et al. Determinants of vascular function in patients with type 2 diabetes. Cardiovasc Diabetol 2012; 11 (1): 127.

    Article  CAS  Google Scholar 

  24. Teoh WL, Price JF, Williamson RM, Payne R a, Van Look L a F, Reynolds RM et al. Metabolic parameters associated with arterial stiffness in older adults with Type 2 diabetes: the Edinburgh Type 2 Diabetes Study. J Hypertens 2013; 31 (5): 1010–1017.

    Article  CAS  Google Scholar 

  25. Aronson D . Cross-linking of glycated collagen in the pathogenesis of arterial and myocardial stiffening of aging and diabetes. J Hypertens 2003; 21 (1): 3–12.

    Article  CAS  Google Scholar 

  26. Yamagishi S . Role of advanced glycation end products (AGEs) and receptor for AGEs (RAGE) in vascular damage in diabetes. Exp Gerontol 2011; 46 (4): 217–224.

    Article  CAS  Google Scholar 

  27. Safar ME, Plante GE, Mimran A . Arterial stiffness, pulse pressure, and the kidney. Am J Hypertens 2015; 28 (5): 561–569.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Sacro Cuore Hospital, Verona, Italy

    D Agnoletti

  2. Paris Descartes University, Hôtel-Dieu Hospital, Paris, France

    D Agnoletti, J Blacher & M E Safar

  3. Department of Internal Medicine of Tizi Ouzou Hospital, Tizi Ouzou, Algeria

    A S Mansour & S Ouerdane

  4. Department of Cardiology Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China

    Y Zhang

  5. 1st Department of Propaedeutic Medicine, Hypertension Center and Cardiovascular Research Laboratory, ‘Laiko’ Hospital Medical School National and Kapodistrian University of Athens, Athens, Greece

    A D Protogerou

  6. Department of Internal Medicine and Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands

    A D Protogerou

Authors
  1. D Agnoletti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A S Mansour
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A D Protogerou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S Ouerdane
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J Blacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M E Safar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M E Safar.

Ethics declarations

Competing interests

AP has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement number '299086 MMC FP7-PEOPLE-2011-IEF'. All the other authors declared no competing interest concerning this paper. No relation with industry was declared.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agnoletti, D., Mansour, A., Zhang, Y. et al. Clinical interaction between diabetes duration and aortic stiffness in type 2 diabetes mellitus. J Hum Hypertens 31, 189–194 (2017). https://doi.org/10.1038/jhh.2016.58

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jhh.2016.58

This article is cited by

Search

Advanced search

Quick links