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Why the radial augmentation index is low in patients with diabetes: The J-HOP study
Kazuo Eguchi1, Satoshi Hoshide1, Hiroshi Miyashita1
1Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Insights
Radial augmentation index (rAI) is lower in diabetes (DM) patients due to arterial stiffening. This study explains why DM patients have reduced aortic wave reflection, impacting cardiovascular health.
Area of Science:
- Cardiovascular Physiology
- Arterial Biomechanics
- Metabolic Disease Research
Background:
- The radial augmentation index (rAI), a measure of aortic wave reflection, is paradoxically lower in patients with diabetes (DM) despite advanced atherosclerosis.
- Understanding this discrepancy is crucial for assessing cardiovascular risk in diabetic populations.
Purpose of the Study:
- To investigate the underlying reasons for the lower rAI observed in patients with DM compared to non-DM individuals.
- To elucidate the relationship between arterial properties, wave reflection, and diabetes status.
Main Methods:
- Radial applanation tonometry was performed on 1787 subjects with at least one cardiovascular risk factor.
- rAI was calculated as the ratio of late systolic shoulder pressure amplitude (PP2) to radial pulse pressure (rPP).
- Central blood pressure parameters were estimated from radial pressure waveforms.
Main Results:
- Patients with DM exhibited significantly lower rAI (83.3 ± 14.1%) compared to non-DM subjects (87.3 ± 15.7%).
- Conversely, DM patients had higher clinic pulse pressure and central pulse pressure (cPP).
- Estimated glomerular filtration rate (eGFR) and insulin resistance (HOMA-IR) were identified as significant determinants of rAI in DM and non-DM groups, respectively.
Conclusions:
- Lower rAI in DM, associated with higher cPP, suggests proximal arterial stiffening reduces wave reflection.
- Decreased renal function in DM may contribute to increased cPP, potentially masking augmentation pressure changes.
- These findings highlight distinct arterial mechanics in diabetes that influence cardiovascular risk assessment.
Background:
Radial augmentation index (rAI), a marker of aortic wave reflection, is usually lower in patients with diabetes (DM) than in non-DM subjects, even though atherosclerotic change is advanced in DM.
Objective:
We sought to explore why rAI in DM is lower than in non-DM.
Methods:
We performed radial applanation tonometry in 1787 subjects who had at least one cardiovascular risk factor. The rAI was defined as [late systolic shoulder pressure amplitude (PP2)]/[radial pulse pressure (rPP)]. The late systolic shoulder blood pressure (SBP2) and PP2 of a radial pressure wave were used as estimates of the central SBP and PP (cPP), respectively.
Results:
The age (65.8 ± 9.8 vs. 65.8 ± 12.1 yrs) and mean brachial SBP (141 ± 16 vs. 141 ± 17 mmHg) were similar between the DM and non-DM groups. The rAI was significantly lower in the DM group (83.3 ± 14.1 vs. 87.3 ± 15.7%, p < 0.001), but clinic PP (62 ± 14 vs. 59 ± 14 mmHg, p < 0.001) and cPP (51 ± 15 vs. 49 ± 15 mmHg, p = 0.019) were significantly greater in the DM group than in the non-DM group. In multivariable analyses adjusting for covariates, the significant determinants of rAI were the estimated glomerular filtration rate (eGFR) (β = 0.17, p < 0.001) in the DM group, and the log-transformed homeostatic model assessment of insulin resistance (HOMA-IR) (β = -0.15, p < 0.001) in the non-DM group. The same trends were also seen for central SBP and cPP.
Conclusions:
The lower rAI in DM associated with higher cPP compared to non-DM suggests proximal conduit-predominant arterial stiffening causing reduced reflection coefficients at systemic reflection sites. As renal function decreases, a cPP increase may overcome the increase of augmentation pressure in the DM group.
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