Links between insulin resistance, inflammation and subclinical macrovascular disease in type 2 diabetes
Year: 2005
Type: dissertation
Abstract: Background and aims.Type 2 diabetic patients have a three-to four-fold risk of cardiovascular disease.A cluster of cardiovascular risk factors has been identifi ed (high blood pressure, high triglycerides, low HDL cholesterol, obesity, impaired glucose metabolism), which together constitutes the metabolic syndrome.The metabolic syndrome affects up to 80 per cent of type 2 diabetic patients.Infl ammation, endothelial activation, and the growth factor system derangement are all novel cardiovascular risk factors.The present studies were undertaken to explore the roles of the insulin-like growth factor system, low-grade infl ammation, and endothelial dysfunction in relation to incipient atherosclerosis, traditional cardiovascular risk markers, and the metabolic syndrome especially in type 2 diabetes. Subjects and methods.Two hundred and thirty-nine type 2 diabetic subjects aged 50 to 75 were recruited from participants of the FIELD (Fenofi brate Intervention and Event Lowering in Diabetes) study at the Helsinki centre.Additionally, a healthy control group (N = 93) was also recruited.The examinations were performed during the placebo run-in phase of the FIELD study for the diabetic patients.An extensive list of lipids and lipoproteins, infl ammatory markers, endothelial markers, and IGF system variables was determined.Albumin excretion rate was measured.Carotid arteries were scanned for the determination of intima-media thickness (IMT) as a surrogate marker of atherosclerosis.Pulsewave analysis (PWA) was performed to determine central arterial augmentation and augmentation index (AIx) to measure arterial stiffness.In a subset (N = 99), carotid scans were reread to determine the severity of local soft and mineralised vessel wall thickening.Results.Compared with the control group, IMT was thicker in diabetic subjects.Blood pressure, age, gender, the duration of diabetes, dyslipidaemia, and obesity were positively related to IMT in diabetic subjects.In contrast, insulin-like growth factor binding protein-1 (IGFBP-1) was inversely related to IMT in diabetic subjects.In healthy subjects, the determinants of IMT were age, infl ammation, endothelial activation, LDL cholesterol, and insulin resistance, but not blood pressure.Among diabetic subjects IGFBP-1 was a marker of insulin sensitivity and inversely related to the severity of the metabolic syndrome.Low-grade infl ammation and endothelial dysfunction were enhanced in type 2 diabetes.Among diabetic patients, the severity of the metabolic syndrome correlated strongly with the levels of markers for infl ammation and endothelial activation.The concentrations of these markers were not related to clinical cardiovascular disease among diabetic patients.Central pressure augmentation, ABSTR ACT
Source: Työväentutkimus Vuosikirja
Author: Eeva Leinonen
Language: English
Subfield: Endocrinology, Diabetes and Metabolism
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Helsingin Yliopisto
OpenAlex ID: W280805969