Diastolic Pressure And Acr Are Modifiable Risk Factors Of Arterial Stiffness In T2DM Without Cardiovascular Disease

Aim: To evaluate early, before the onset of cardiovascular events and of chronic renal insufficiency, the association between CKD-mineral bone disorder biomarkers and vascular stiffness (Cardio Ankle Vascular Index, CAVI) in the course of type 2 diabetes (T2DM). Method: we evaluated 174 T2DM patients (median age 56 y; M/F = 100/74) with diabetes duration less than 10 years and without decreased glomerular filtration rate (eGFR ≥60 ml/min/1.73 m 2) or macrovascular complications. Thirty-four age matched healthy subjects (M/F: 13/21; age: 53.5[50.0-57.7] y.o; eGFR 107.5[97.0-119.7]) ml/ml/min1.73m2) served as local reference control for CAVI (pathological: ≥8) and the novel CKD-MBD biomarkers. Results: albumin-to-creatinine ratio (ACR) averaged 8.5 mg/g [5.6-17.2] with 12.6% of the patients showing pathologic values, indicative of incipient diabetic nephropathy (DN). Serum parathyroid hormone, Fibroblast Growth Factor 23 and Sclerostin were higher while 1,25-dihydroxyvitamin D and Klotho were lower than a control group. CAVI was normal (<8) in only 54% and correlated positively with age (p<.001), Hb1A1c (p=.036), systolic (p=.021) and diastolic blood pressure (DBP) (p=.001) and negatively with 25D (p=.046). In multivariate analysis, age, DBP, ACR, and s-Klotho were independent positive predictors of CAVI. Conclusion: in the absence of overt cardiovascular disease and of chronic renal insufficiency, CAVI is frequently pathologic in T2DM. DBP, and ACR are modifiable risk factors of vascular stiffness in T2DM thus warranting optimal assessment.