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

Thomas H. Schindler, Jerson Cadenas, Alvaro D. Facta, Yanjie Li, Manfred Olschewski, James Sayre, Jonathan Goldin, Heinrich R. Schelbert

Research output: Contribution to journalArticlepeer-review

38 Scopus citations

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 resultsIn 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 ΔMBF 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 ΔMBF 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).ConclusionIn 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.

Original languageEnglish
Pages (from-to)3064-3073
Number of pages10
JournalEuropean heart journal
Volume30
Issue number24
DOIs
StatePublished - Dec 2009

Keywords

  • Cardiovascular disease prevention
  • Carotid IMT
  • Coronary artery calcification
  • Coronary circulation
  • Diabetes mellitus
  • Endothelium
  • Positron emission tomography

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