The Earliest Signs of Endothelial Dysfunction in Men with Type 2 Diabetes, without Clinical Symptoms of Cardiovascular Disease

Presentation Number: SAT 517
Date of Presentation: April 1st, 2017

Irina Khripun1, Sergey Vorobyev2, Elena Bova*3, Michael Kogan2 and Michael Zitzmann4
1Rostov State Medical University, Rostov-on- Don, Russia, 2Rostov State Medical University, Rostov-on-Don, Russia, 3Rostov State Medical University, 4University Clinics Muenster, Muenster, Germany

Abstract

Diabetes mellitus type 2 (T2DM) leads to the progression of endothelial dysfunction (ED), which increases the risks of cardiovascular disease. Recently, the diagnosis of cardiovascular disease is established according to the presence of clinical symptoms. The criteria for the early diagnosis of ED are not well established.

Aim To find the early signs of ED in men with T2DM without clinical symptoms of cardiovascular disease.

Materials and methods. We were examined 250 men with T2DM (mean age 54.6±5.1 years) from which 110 patients were selected with no clinical symptoms of cardiovascular diseases. These patients were divided into 2 groups: the1st one consisted of 62 patients with diabetes duration of up to 5 years, the 2nd one of 48 men with a diabetes history of 5-10 years. Endothelial function was assessed by assessment of plasma levels of nitric oxide (NO), endothelial NO synthase type 3 (eNOS3), ICAM-1, VCAM-1, E-, P-selectin, resistin, C-reactive protein and ultrasonographic determination of arterial vasoreactivity of the brachial artery (BA). The data were analyzed using the Mann Whitney U - test for two independent groups.

Results. The levels of eNOS3 (192,3 [95,1; 645,2] vs 178,6 [118,2; 341,1], p = 0.0005) and NO (103,5 [67,8; 292,6] vs 69,8 [51,2; 119], p = 0.043) were higher in the 1st group compared to the 2nd one. In the 2nd group the levels of VCAM-1were higher by 12.1% (p = 0.048), resistin by 62% (p = 0.01), C-reactive protein by 45.6%, compared to the 1st group. This indicates the raise of cardiovascular risk with increasing the duration of diabetes more that 5 years, even in the absence of clinical signs of cardiovascular disease.

There was a decrease in the arterial vasoreactivity in the 2nd (10,2 [6,4; 16,4]%) as compared to the 1st group (13,0 [10; 17]%), which remained in the normal range. Therefore, the time until the maximum vasodilatation of the BA was higher in the 2nd group (105 [90; 180] seconds) compared to the 1st one (90 [60; 120] seconds).

Biochemical and instrumental signs of ED in men with T2DM appear long before the clinical manifestation of cardiovascular diseases. The earliest markers of ED are the reduction of eNOS3 and NO levels, the increase of VCAM-1 and resistin concentrations, and the increase in the time until the maximum vasodilatation of BA – a new ultrasound index of ED.

 

Nothing to Disclose: IK, SV, EB, MK, MZ