Flow-Mediated Dilation Can Help Predict Arterial Stiffness in Type 1 Diabetes

Kaitlin Love, MD

A recent study is providing insight into predictors of arterial stiffness in patients with type 1 diabetes.

Leveraging carotid-femoral pulse wave velocity (cfPWV) from a cohort of young adults and adolescents with type 1 diabetes, investigators determined age, sex, and flow-mediated dilation (FMD) were uniquely associated with arterial stiffness in type 1 diabetes, which was not observed with other factors such as duration of diabetes, HbA1c, or heart rate.

“Age, sex, and FMD were the only factors uniquely associated with cfPWV in our cohort of adolescents and adults with uncomplicated type 1 DM. Male participants had higher cfPWV, indicating greater central arterial stiffness, but similar FMD and AIx to female participants,” wrote investigators.

Although it is well-established patients with type 1 diabetes face an increased risk of increased arterial stiffness, relatively few studies provide insight into predictors of arterial stiffness among younger patients with type 1 diabetes. With this in mind, a team of investigators from the University of Virginia Health System sought to assess the relationship between cfPWV and age, duration of diabetes, sex, HbA1c, augmentation index, mean arterial pressure, FMD, and heart rate.

Led by Kaitlin Love, MD, and Eugene Barrett, MD, the study included a cohort of 41 participants, including 16 adolescents and 25 adults. The cohort had a mean age of 24 years, a mean duration of diabetes of 14 years, a mean HbA1c of 7.9%, and 34% were female. Investigators pointed out male and female participants were similar in age, diabetes duration, HbA1c, blood pressure, BMI, and lipid profile.

Inclusion criteria included having a BMI below 30 kg/m2, an HbA1c below 9%, and blood pressure below 160/90 mmHg at the time of screening. Additionally, patients were excluded if they were current smokers or had quit smoking in the prior 6 months, were taking vasoactive medications outside of antihypertensive medication, or had any history of cardiovascular, peripheral vascular, or liver disease.

Upon analysis, only age, sex, and FMD were associated with arterial stiffness in adolescents and adults with uncomplicated toys 1 diabetes. Although men and women included in the study had similar cardiovascular risk factors, male patients with diabetes had higher cfPWV than women with diabetes, but no differences were observed for any other macrovascular outcomes, including FMD and AIx.

Endothelial dysfunction was highly prevalent among our participants regardless of DM duration. Further study is warranted to determine the generalizability of our results and define the sequence of and sex differences in macrovascular dysfunction present in type 1 DM,” wrote investigators.

This study, “Predictors of arterial stiffness in adolescents and adults with type 1 diabetes: a cross-sectional study,” was published in BMJ Open Diabetes Research and Care.