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Scientific article
English

Improvement in coronary endothelial function is independently associated with a slowed progression of coronary artery calcification in type 2 diabetes mellitus

Published inEuropean heart journal, vol. 30, no. 24, p. 3064-3073
Publication date2009
Abstract

AIMS: To examine a relationship between alterations of structure and function of the arterial wall in response to glucose-lowering therapy in type 2 diabetes mellitus (DM) after a 1-year follow-up (FU). METHODS AND RESULTS: In DM (n = 22) and in healthy controls (n = 17), coronary artery calcification (CAC) was assessed with electron beam tomography and carotid intima-media thickness (IMT) with ultrasound, whereas coronary function was determined with positron emission tomography-measured myocardial blood flow (MBF) at rest, during cold pressor testing (CPT), and during adenosine stimulation at baseline and after FU. The decrease in plasma glucose in DM after a mean FU of 14 +/- 1.9 months correlated with a lower progression of CAC and carotid IMT (r = 0.48, P ≤ 0.036 and r = 0.46, P ≤ 0.055) and with an improvement in endothelium-related DeltaMBF to CPT and to adenosine (r = 0.46, P ≤ 0.038 and r = 0.36, P ≤ 0.056). After adjusting for metabolic parameters by multivariate analysis, the increases in DeltaMBF to CPT after glucose-lowering treatment remained a statistically significant independent predictor of the progression of CAC (P ≤ 0.001 by one-way analysis of variance). CONCLUSION: In DM, glucose-lowering treatment may beneficially affect structure and function of the vascular wall, whereas the observed improvement in endothelium-related coronary artery function may also mediate direct preventive effects on the progression of CAC.

Keywords
  • Adult
  • Calcinosis/*drug therapy/physiopathology
  • Carotid Artery Diseases/pathology
  • Coronary Artery Disease/*drug therapy/pathology/physiopathology
  • Coronary Circulation/drug effects
  • Diabetes Mellitus, Type 2/*drug therapy/pathology/physiopathology
  • Diabetic Angiopathies/*drug therapy/pathology/physiopathology
  • Disease Progression
  • Endothelium, Vascular/physiology
  • Female
  • Humans
  • Hypoglycemic Agents/*therapeutic use
  • Male
  • Middle Aged
  • Positron-Emission Tomography
  • Tunica Intima/pathology
  • Tunica Media/pathology
Citation (ISO format)
SCHINDLER, Thomas et al. Improvement in coronary endothelial function is independently associated with a slowed progression of coronary artery calcification in type 2 diabetes mellitus. In: European heart journal, 2009, vol. 30, n° 24, p. 3064–3073. doi: 10.1093/eurheartj/ehp482
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ISSN of the journal0195-668X
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