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The role of vascular function in patients with diabetic retinopathy

Session Endothelial cell function: bedside to bench

Speaker Evangelos Oikonomou

Event : ESC Congress 2014

  • Topic : basic science
  • Sub-topic : Basic Science - Vascular Biology and Physiology
  • Session type : Moderated Posters

Authors : N Gouliopoulos (Athens,GR), G Siasos (Athens,GR), D Tousoulis (Athens,GR), M Moschos (Athens,GR), E Oikonomou (Athens,GR), C Kollia (Athens,GR), G Siasou (Athens,GR), S Mazaris (Athens,GR), T Konsola (Athens,GR), C Stefanadis (Athens,GR)

N. Gouliopoulos1 , G. Siasos1 , D. Tousoulis1 , M. Moschos2 , E. Oikonomou1 , C. Kollia1 , G. Siasou2 , S. Mazaris1 , T. Konsola1 , C. Stefanadis1 , 1University of Athens Medical School, 1st Cardiology Department, “Hippokration” Hospital - Athens - Greece , 2University of Athens Medical School, Department of Ophthalmology - Athens - Greece ,

European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 1047

Purpose: Diabetic Retinopathy (DR) is a complication of diabetes mellitus and remains a leading cause of irreversible blindness. Measurement of endothelial function and arterial stiffness are well validated in large population studies as strong predictor of adverse cardiovascular outcomes. We investigated the possible association of DR with endothelial function, arterial stiffness and inflammation.

Methods: We enrolled 100 consecutive subjects with DR (mean age 69±9 years), 100 consecutive subjects with diabetes but no evidence of DR (NDR) (mean age 64±10 years) and 100 healthy subjects (mean age 63±11 years). Endothelial function was evaluated by flow mediated dilation (FMD) in the brachial artery, carotid-femoral pulse wave velocity (PWV) was measured as an index of arterial stiffness and augmentation index (AIx) as an index of reflected waves. Creatinine clearance, glycosylated hemoglobin, and C reactive protein were measured.

Results: Patients with DR compared to NDR patients and healthy subjects had impaired FMD (3.55±1.23% vs. 5.71±1.92% vs. 7.54±3.06%, p<0.001), increased PWV (11.06±2.75m/sec vs. 9.16±1.97m/sec vs. 8.41±1.75m/sec, p<0.001) and increased AIx (27.85±8.15% vs. 24.12±7.96% vs. 22.52±8.00%, p<0.001). In diabetic patients, we applied a forward logistic regression model, which revealed that impaired FMD was the strongest predictor of the presence of DR [Odds ratio=0.34, 95%CI (0.23, 0.51), p<0.001]. As many confounders may exists, we applied a second logistic regression model which revealed that impaired FMD was independently associated with the presence of DR [Odds ratio=0.17, 95%CI (0.074, 0.394), p<0.001] even after adjustments for confounders such as sex, age, glycosylated hemoglobin and C reactive protein levels, duration of diabetes, body mass index, type of treatment and the presence of arterial hypertension and dyslipedemia. Moreover, among diabetes mellitus patients ROC curve analysis revealed that FMD has sufficient discriminate ability to detect DR (AUC=0.85, 95%CI 0.80 to 0.91, p<0.001) and an FMD value below 4.35% has a sensitivity of 82%, and a specificity of 79% for the diagnosis of DR. Importantly, the negative predictive value of an FMD above 4.36% was estimated at 85%.

Conclusion: This study showed that DR patients have significantly impaired endothelial function and increased arterial stiffness compared to NDR patients and to healthy people. Importantly, impaired FMD is strongly and independently associated with the occurrence of DR highlighting the role of dysfunctional endothelium in the progression of microvascular diabetic complications.

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