1Department of Medicine, Graduate School of Medicine, Kyung Hee University, Seoul, Korea.
2Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea.
Copyright © 2018 Korean Diabetes Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The Relationship Between Glycemic Control and Concomitant Hypertension on Arterial Stiffness in Type II Diabetes
Characteristic | Total (n=219) | ASCVD (n=39) | Non-ASCVD (n=180) | P value |
---|---|---|---|---|
Age, yr | 58.8±9.7 | 62.0±9.9 | 58.1±9.5 | 0.022 |
Sex | 0.876 | |||
Men | 126 (57.5) | 22 (56.4) | 104 (57.8) | |
Women | 93 (42.5) | 17 (43.6) | 76 (42.2) | |
Height, cm | 162.3±8.8 | 160.1±7.8 | 162.8±8.9 | 0.080 |
Weight, kg | 67.3±11.2 | 67.9±10.7 | 67.1±11.3 | 0.686 |
Body mass index, kg/m2 | 25.5±3.2 | 26.4±2.4 | 25.3±3.3 | 0.049 |
Waist circumference, cm | 90.6±9.4 | 95.3±11.9 | 89.5±8.5 | <0.001 |
Duration of diabetes mellitus, yr | 9.0±6.7 | 9.4±6.7 | 8.8±6.7 | 0.615 |
Past medical history Hypertension | 144 (65.8) | 35 (89.7) | 109 (60.6) | <0.001 |
Cardiovascular disease | 13 (5.9) | 13 (5.9) | - | |
Cerebral vascular disease | 28 (12.8) | 28 (12.8) | - | |
Medication history Antihypertensive agents | 144 (65.8) | 35 (89.7) | 109 (60.6) | <0.001 |
Antiplatelet agents | 121 (55.3) | 33 (84.6) | 88 (48.9) | <0.001 |
Lipid lowering agents | 124 (56.6) | 32 (82.1) | 92 (51.1) | <0.001 |
Smoking | 43 (19.6) | 10 (25.6) | 33 (18.3) | 0.298 |
Drinking | 33 (15.1) | 8 (20.5) | 25 (13.9) | 0.294 |
Exercise | 0.727 | |||
<Twice per a week | 101 (46.1) | 17 (43.6) | 84 (46.7) | |
≥Twice per a week | 118 (53.9) | 22 (56.4) | 96 (53.3) | |
Systolic blood pressure, mm Hg | 128±14 | 130±13 | 127±14 | 0.356 |
Diastolic blood pressure, mm Hg | 77±10 | 79±13 | 77±10 | 0.391 |
Heart rate, beat/min | 76±12 | 73±14 | 76±12 | 0.139 |
WBC, ×1,000/µL | 7.00±2.12 | 6.99±1.90 | 7.00±2.17 | 0.976 |
GOT, IU/L | 25.5±18.6 | 23.7±8.7 | 25.9±20.2 | 0.497 |
GPT, IU/L | 25.3±18.3 | 22.9±11.9 | 25.9±19.4 | 0.367 |
GGT, IU/L | 45.6±60.7 | 54.1±60.4 | 43.8±60.8 | 0.350 |
HbA1c, % | 7.4±1.3 | 7.4±1.5 | 7.4±1.2 | 0.988 |
Total cholesterol, mg/dL | 164.5±45.9 | 158.9±34.8 | 172.8±35.5 | 0.027 |
Triglyceride, mg/dL | 151.6±108.3 | 172.0±121.6 | 148.3±108.0 | 0.226 |
HDL-C, mg/dL | 51.7±15.3 | 48.1±12.3 | 51.6±13.1 | 0.134 |
LDL-C, mg/dL | 96.9±23.4 | 85.9±29.5 | 99.4±32.3 | 0.018 |
BUN, mg/dL | 15.1±4.0 | 15.5±4.9 | 15.0±3.7 | 0.493 |
Creatinine, mg/dL | 0.8±0.2 | 0.8±0.2 | 0.7±0.2 | 0.072 |
eGFR, mL/min/1.73 m² | 109.1±30.0 | 99.8±30.5 | 111.1±29.6 | 0.037 |
hsCRP, mg/L | 1.4±2.9 | 1.2±1.9 | 1.5±3.0 | 0.580 |
Microalbuminuria, mg/day | 42.2±87.8 | 48.2±80.0 | 40.9±89.5 | 0.650 |
CAVI | 8.2±1.4 | 8.8±1.4 | 8.1±1.3 | 0.004 |
CAVI <8 | 103 (47.0) | 11 (28.2) | 92 (51.1) | 0.012 |
8≤CAVI<9 | 62 (28.3) | 12 (30.8) | 50 (27.8) | |
CAVI ≥9 | 54 (24.7) | 16 (41.0) | 38 (21.1) | |
ABI | 1.1±0.1 | 1.1±0.2 | 1.1±0.1 | 0.108 |
ABI <0.9 | 3 (1.4) | 2 (5.1) | 1 (0.6) | 0.026 |
0.9≤ABI≤1.3 | 216 (98.6) | 37 (94.9) | 179 (99.4) | |
ABI ≤1.3 | 0 | 0 | 0 | |
Mean IMT, mm | 1.01±0.23 | 1.12±0.28 | 0.99±0.21 | 0.009 |
Maximal IMT, mm | 1.28±0.30 | 1.40±0.35 | 1.26±0.29 | 0.006 |
Atherosclerosis | ||||
Mean IMT ≥1 mm | 107 (48.9) | 26 (66.7) | 81 (45.0) | 0.014 |
Maximal IMT ≥1 mm | 154 (83.3) | 36 (92.3) | 152 (84.4) | 0.202 |
Mean IMT ≥1 mm or with plaque | 158 (72.1) | 34 (87.2) | 124 (68.9) | 0.021 |
Maximal IMT ≥1 mm or with plaque | 201 (91.8) | 39 (100) | 162 (90.0) | 0.039 |
Plaque | 154 (70.3) | 34 (87.2) | 120 (66.7) | 0.011 |
Metabolic syndrome | 189 (86.3) | 39 (100) | 150 (83.3) | 0.006 |
Number of risk factor | 3.1±1.0 | 4.0±0.7 | 3.3±1.0 | <0.001 |
Characteristic | CAVI <8 (n=92) | 8≤CAVI<9 (n=50) | CAVI ≥9 (n=38) | P value |
---|---|---|---|---|
Age, yra,b,c | 53.0±8.9 | 61.4±6.1 | 66.3±7.0 | <0.001 |
Sex | 0.139 | |||
Men | 57 (62.0) | 23 (46.0) | 24 (63.2) | |
Women | 35 (38.0) | 27 (54.0) | 14 (36.8) | |
Height, cma | 164.5±8.0 | 160.5±9.6 | 161.8±9.3 | 0.030 |
Weight, kga,b | 70.3±11.7 | 64.3±10.2 | 63.2±9.6 | <0.001 |
Body mass indexb, kg/m2 | 25.9±3.4 | 24.9±3.2 | 24.1±2.8 | 0.014 |
Waist circumference, cm | 89.8±8.9 | 89.4±8.9 | 89.1±86.9 | 0.912 |
Duration of diabetes mellitus, yr | 8.0±5.5 | 8.2±6.2 | 11.7±9.0 | 0.072 |
Hypertension | 49 (53.3) | 31 (62.0) | 29 (76.3) | 0.049 |
Medication history Antihypertensive agents | 49 (53.3) | 31 (62.0) | 29 (76.3) | 0.049 |
Antiplatelet agents | 42 (45.7) | 24 (48.0) | 22 (57.9) | 0.442 |
Lipid lowering agents | 48 (52.2) | 23 (46.0) | 21 (55.3) | 0.662 |
Smoking | 19 (20.7) | 8 (16.0) | 6 (15.8) | 0.713 |
Drinking | 13 (14.1) | 5 (10.0) | 7 (18.4) | 0.525 |
Exercise | 0.720 | |||
<Twice per a week | 44 (47.8) | 21 (42.0) | 19 (50.0) | |
≥Twice per a week | Weight, kga,b | 29 (58.0) | 19 (50.0) | |
Systolic blood pressure, mm Hgb,c | 125±13 | 126±13 | 136±15 | <0.001 |
Diastolic blood pressure, mm Hg | 78±10 | 75±10 | 79±9 | 0.060 |
Heart rate, beat/minc | 76±12 | 73±11 | 80±13 | 0.024 |
WBC, ×1,000/µL | 6.70±1.96 | 7.36±2.58 | 7.24±2.00 | 0.182 |
GOT, IU/La | 29.4±27.3 | 21.5±5.0 | 23.4±7.8 | 0.024 |
GPT, IU/La,b | 30.6±24.8 | 19.9±8.0 | 22.3±10.7 | 0.002 |
GGT, IU/L | 51.1±79.8 | 32.2±25.5 | 40.7±30.6 | 0.220 |
HbA1c, % | 7.3±1.2 | 7.3±1.3 | 7.7±1.1 | 0.165 |
Total cholesterol, mg/dL | 173.4±35.4 | 173.8±36.1 | 169.8±35.7 | 0.845 |
Triglyceride, mg/dL | 157.7±123.2 | 127.4±98.2 | 153.2±74.3 | 0.267 |
HDL-C, mg/dLa,c | 50.3±12.1 | 56.3±14.8 | 48.4±11.7 | 0.008 |
LDL-C, mg/dL | 100.0±31.4 | 98.9±35.5 | 98.2±30.9 | 0.953 |
BUN, mg/dL | 14.6±3.4 | 15.3±4.5 | 15.4±3.4 | 0.368 |
Creatinine, mg/dL | 0.75±0.19 | 0.70±0.22 | 0.75±0.20 | 0.376 |
hsCRP, mg/L | 1.1±1.8 | 1.8±2.7 | 2.0±5.1 | 0.251 |
Microalbuminuria, µg/mg Cr | 30.5±67.1 | 31.4±88.7 | 78.6±123.9 | 0.083 |
ABIb | 1.12±0.07 | 1.11±0.07 | 1.08±0.08 | 0.013 |
ABI <0.9 | 0 | 0 | 1 (2.6) | 0.153 |
0.9≤ABI≤1.3 | 92 (100) | 50 (100) | 37 (97.4) | |
Mean IMT, mmb | 0.94±0.18 | 1.00±0.20 | 1.09±0.27 | 0.001 |
Maximal IMT, mmb | 1.21±0.27 | 1.26±0.28 | 1.37±0.31 | 0.012 |
Atherosclerosis | ||||
Mean IMT ≥1 mm | 31 (33.7) | 26 (52.0) | 24 (63.2) | 0.005 |
Maximal IMT ≥1 mm | 74 (80.4) | 41 (82.0) | 37 (97.4) | 0.045 |
Mean IMT ≥1 mm or with plaque | 50 (54.3) | 40 (80.0) | 34 (89.5) | <0.001 |
Maximal IMT ≥1 mm or with plaque | 79 (85.9) | 45 (90.0) | 38 (100) | 0.051 |
Plaque | 47 (51.1) | 40 (80.0) | 33 (86.8) | <0.001 |
Metabolic syndrome | 58 (63.0) | 34 (68.0) | 32 (86.5) | 0.032 |
Number of risk factorb,c | 3.2±1.0 | 3.2±1.0 | 3.7±0.7 | 0.007 |
10-Year ASCVD risk, %b,c | 10.1±8.4 | 14.0±9.2 | 26.9±16.3 | <0.001 |
Variable | Total subjects | Non-ASCVD | |||||
---|---|---|---|---|---|---|---|
ABI | CAVI | Mean IMT, mm | ABI | CAVI | Mean IMT, mm | Maximal IMT, mm | |
CAVI | −0.184a | −0.138 | |||||
Mean CA IMT, mm | −0.089 | 0.364b | −0.022 | 0.338b | |||
Maximal CA IMT, mm | −0.065 | 0.338b | 0.929b | −0.004 | 0.302b | 0.919b | |
10-Year ASCVD risk | −0.034 | 0.481b | 0.346b | 0.291b | |||
Numbers of MS risk factors | −0.099 | 0.141 | 0.168a | 0.176a |
CAVI | P value | |
---|---|---|
Total subjects | ||
Model 1 (ASCVD)a | 1.38 (1.06–1.80) | 0.017 |
Non-ASCVD group | ||
Model 2 (atherosclerosis [mean IMT ≥1 mm])b | 1.53 (1.12–2.08) | 0.007 |
Model 3 (high 10-year ASCVD risk [≥7.5%])c | 2.42 (1.64–3.58) | <0.001 |
Values are presented as mean±standard deviation or number (%). For ASCVD, atherosclerotic cardiovascular disease; WBC, white blood cell; GOT, glutamate oxaloacetate transaminase; GPT, glutamate pyruvate transaminase; GGT, γ-glutamyltransferase; HbA1c, glycosylated hemoglobin; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; BUN, blood urea nitrogen; eGFR, estimated glomerular filtration rate; hsCRP, high-sensitivity C-reactive protein; CAVI, cardio-ankle vascular index; ABI, ankle-brachial index; IMT, intima media thickness.
Values are presented as mean±standard deviation or number (%). For CAVI, cardio-ankle vascular index; ASCVD, atherosclerotic cardiovascular disease; WBC, white blood cell; GOT, glutamate oxaloacetate transaminase; GPT, glutamate pyruvate transaminase; GGT, γ-glutamyltransferase; HbA1c, glycosylated hemoglobin; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; BUN, blood urea nitrogen; hsCRP, high-sensitivity C-reactive protein; ABI, ankle-brachial index; IMT, intima media thickness. a
aCAVI, cardio-ankle vascular index; IMT, intima media thickness; ABI, ankle-brachial index; ASCVD, atherosclerotic cardiovascular disease; CA, carotid artery; MS, metabolic syndrome. Spearman's correlation analysis, a
Values are presented as β (95% confidence interval). Multivariable logistic regression analysis, CAVI, cardio-ankle vascular index; ASCVD, atherosclerotic cardiovascular disease; IMT, intima media thickness. aModel 1: adjusted by age, gender, diabetes mellitus (DM) duration, body mass index (BMI), smoking, lipid lowering agents, and antihypertensive agents, bModel 2: adjusted by age, gender, DM duration, BMI, smoking, lipid lowering agents, and antihypertensive agents, cModel 3: adjusted by DM duration, BMI, and lipid lowering agents.