Increased augmentation of central blood pressure is associated with increases in carotid intima-media thickness in type 2 diabetic patients

Aims/hypothesis: Type 2 diabetes is associated with a two- to seven-fold increase in cardiovascular morbidity and mortality. The aim of this study was to determine the relationships between intima-media thickness (IMT), an established marker of atherosclerosis, large artery function and other determinants of cardiovascular risk in type 2 diabetic patients. Methods: We studied 228 type 2 diabetic patients (75 women, aged 62 +/- 2 years [mean +/- SEM]). Carotid IMT was bilaterally measured using ultrasound technology. Applanation tonometry and pulse wave analysis were used to measure aortic systolic and diastolic blood pressures, central pressure augmentation (AG) and the augmentation index (AIx), a measure of systemic arterial stiffness. Conventional cardiovascular risk factors (lipids, HbA(1)c, smoking and diabetes duration) were also assessed. Results: Women had higher AG and AIx (p < 0.0001), despite comparable systolic BP and heart rate in women and men. In women, AG (r=0.39, p < 0.001), age (r=0.32, p < 0.01), brachial systolic BP (r=0.34, p < 0.01) and aortic systolic BP (r=0.34, p < 0.01) correlated with IMT. In men, age (r=0.41, p < 0.001), diabetes duration (r=0.25, p < 0.01), AG (r=0.22, p < 0.01), aortic systolic BP (r=0.21, p < 0.01), brachial systolic BP (r=0.21, p < 0.01) and body weight (r=0.16, p < 0.05) correlated with IMT. In multiple linear regression analyses, AG and aortic systolic BP, but not brachial systolic BP, were age-independent determinants of IMT in men and women. In all patients, increased AG (adjusted for sex, age and heart rate) correlated with longer duration of diabetes, urinary albumin excretion and IMT. Conclusion/interpretation: Measures of central systolic pressure correlate with carotid IMT, independently of age and other risk markers.