Hyperglycemia Plays A Key Role in Vascular Dysfunction
Despite differences in pathophysiology and metabolism,
patients with type 1 and type 2 diabetes do not
differ with respect to coronary vasodilator function.
That, according to findings reported in the April
16th issue of the Journal of the American College
of Cardiology. Thus, the study authors maintain,
the common denominator -- chronic hyperglycemia --
likely plays a key role in the pathogenesis of vascular
dysfunction.
Dr. Marcelo F. Di Carli and associates studied
18 subjects with type 1 diabetes, 17 with
type 2 diabetes,
and 11 age-matched control subjects. Diabetic subjects
were asymptomatic, free of overt cardiovascular
disease and similar in age and glycemic control.
Basal myocardial blood blow as measured by positron
emission tomography was similar in the three
groups.
During adenosine-induced hyperemia and during
cold pressor testing, increases in blood flow
did not
differ significantly by type of diabetes but
were markedly reduced compared with controls
(p < 0.001).
The differences persisted after adjusting for duration
of diabetes, body mass index, lipid profile and autonomic
neuropathy.
"
Because the only thing these two groups have in common
is hyperglycemia, then the hyperglycemia is probably
the primary culprit for the abnormalities that one
sees," Dr. Di Carli, currently based at Brigham
and Women's Hospital, Boston, remarked in a press
statement.
It is "kind of scary," he added, "because
even when patients are in their 30s you can already
see these impaired coronary blood flows as an early
sign of atherosclerosis." He recommended further
study of the "synergy between hyperglycemia
and insulin resistance." J Am Coll Cardiol 2003;41:1387-1393.
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