Type 2 diabetes is associated with greater carotid stiffness and greater pressure-dependency of carotid stiffness - The Maastricht Study

Marja Veugen, Thomas van Sloten, Ronald Henry, Evelien Hermeling, Hans-Peter Brunner-LaRocca, Miranda Schram , Pieter Dagnelie, Coen Stehouwer, Koen Reesink

Purpose:
Arterial remodeling underlies the association between type 2 diabetes (T2D) and arterial stiffness. Remodeling may also affect the pressure-dependency of stiffness. Pressure-dependency can be quantified as the systolic-diastolic difference in pulse wave velocity (∆PWV). In the population-based Maastricht Study, we evaluated the associations between carotid stiffness (cPWV) and ∆PWV, and glucose metabolism status (GMS). Additionally, we investigated the interdependency of cPWV and ∆PWV in their association with GMS as to find out whether remodeling may act differentially upon cPWV and ∆PWV.

Methods:
The study consisted of 594 individuals (312 normal glucose metabolism [NGM], 98 impaired glucose metabolism [IGM] and 184 T2D). cPWV and ∆PWV were determined by ultrasonography and tonometry. Regression analyses were used to investigate the associations of cPWV and ∆PWV with GMS (NGM as reference). Models were adjusted for age, sex, mean arterial pressure (MAP), and central pulse pressure, cPWV or ∆PWV as appropriate, and additionally for: anti-hypertensive medication, prior cardiovascular disease, estimated glomerular filtration rate, or body mass index.

Results:
After adjustment for age, sex and MAP, T2D was associated with greater cPWV (β (95% CI; 0.284 (0.0120.556)) and ∆PWV (0.299 (-0.0050.603)). Further adjustments did not change these associations. After additional adjustment for cPWV or ∆PWV the associations with ∆PWV and cPWV attenuated (0.209 (-0.0830.502) and 0.208 (-0.0530.470),  respectively). IGM was not associated with either cPWV or ∆PWV.

Conclusions:
In T2D both cPWV and ∆PWV are increased. The associations were only partially interdependent, which suggests that remodeling  impacts on both stiffness and its pressure-dependency.