Association between arterial stiffness and skin microvascular function in individuals without and with type 2 diabetes

Thomas T van Sloten, Sébastien Czernichow, Alfons JHM Houben, Athanase D Protogerou, Ronald MA Henry, Dennis MJ Muris, Miranda T Schram, Simone JS Sep, Pieter C Dagnelie, Carla JH van der Kallen, Nicolaas C Schaper, Jacques Blacher, Serge Hercberg, Bernard I Levy, Coen DA Stehouwer

Background:
It has been hypothesized that arterial stiffness leads to generalized microvascular dysfunction, and that this may explain the association between stiffness and different diseases, including dementia, kidney dysfunction, neuropathy and osteoporosis. In addition, individuals with type 2 diabetes mellitus (T2DM) may be particularly prone to the detrimental effects of arterial stiffness. However, evidence for an association between stiffness and direct markers of generalized microvascular dysfunction is lacking. The cutaneous microcirculation is a representative vascular bed to examine generalized microvascular phenomena. We therefore investigated the association between arterial stiffness and skin microvascular function in both individuals without and with T2DM.

Methods and results:
Cross-sectional data was used of The SUVIMAX2 Study (n=284; 62.2y; 48.6% women; 0% T2DM (by design)) and The Maastricht Study (n=737; 59.7y; 45.2% women; 28.8% T2DM (by design)). Arterial stiffness was determined by carotid-femoral pulse wave velocity (cfPWV). Skin capillaroscopy was used to determine capillary density at baseline, during reactive hyperemia after arterial occlusion and during venous congestion. Laser Doppler flowmetry was used to assess acetylcholine- and local heating-induced vasoreactivity, and microvascular flowmotion. The results showed that in both individuals without and with T2DM, cfPWV was not associated with baseline capillary density or capillary recruitment during reactive hyperemia or venous congestion. In addition, cfPWV was not associated with acetylcholine- or local heating-induced vasoreactivity, or microvascular flowmotion.

Conclusions:
Arterial stiffness is not associated withskin microvascular function, irrespective of the presence of T2DM. This suggests that the association between stiffness and different diseases cannot be explained by generalized microvascular dysfunction.