in Patients With Coronary Artery Disease
Diabetes Metab Res Rev. 2019 Sep 11
Endothelial dysfunction and cardiovascular outcome in asymptomatic patients with type 2 diabetes mellitus: a pilot study.
Villano A1, Mencarelli E1, Melita V1, Rizzi A1, Lamendola P1, De Vita A1, Manfredonia L1, Ravenna SE1, Pitocco D1, Lanza GA1, Crea F1.
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1
Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Abstract
BACKGROUND:
Type 2 diabetes mellitus (T2DM) is associated with an increased risk of cardiovascular events, but risk stratification of asymptomatic T2DM patients remains a challenging issue. We conducted a pilot study to assess whether endothelial dysfunction might help identify, among asymptomatic T2DM patients, those at increased risk of cardiovascular events.
METHODS:
We studied 61 consecutive T2DM patients with no evidence of cardiovascular disease and no insulin therapy. Endothelial function was assessed by flow-mediated dilation (FMD) of the right brachial artery. The primary endpoint was a combination of major cardiovascular events (MACE: cardiovascular death, acute coronary events, coronary interventions and acute cerebrovascular accidents). FMD was repeated at follow-up in 48 patients (79%).
RESULTS:
A total of 10 MACE (16.4%) occurred during a mean follow-up of 48 months, including 3 acute myocardial infarctions, 5 coronary revascularisations for stable angina and 2 acute ischemic strokes. FMD at enrolment was lower in patients with compared to patients without MACE (3.78±0.97 vs. 4.70±1.33 %, respectively; p=0.04). No other clinical or laboratory variables (age, diabetes duration, glycated hemoglobin, cardiovascular risk factors, drug therapy, nitrate mediated dilation) were associated with MACE. FMD at follow-up was also lower in patients with (n=10) compared to those without (n=38) MACE (3.66±1.29 vs. 4.85±1.92; p=0.006).
CONCLUSIONS:
Our data suggest that assessment of FMD might be helpful to identify patients at increased risk of MACE among individuals with asymptomatic T2DM; accordingly, a large study is warrented to adequately define the clinical utility of FMD assessment in the management of T2DM patients.
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