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Associations of atherosclerosis in the descending thoracic aorta on CTA with arterial stiffness and chronic kidney disease in asymptomatic patients with diabetes mellitus

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Abstract

The relation between atherosclerosis in the descending thoracic aortic (DTA), arterial stiffness and chronic kidney disease (CKD) in patients with diabetes mellitus (DM) remains unclear. The current aim was to evaluate associations of DTA atherosclerosis with arterial stiffness and parameters of CKD in asymptomatic patients with DM. A total of 213 asymptomatic patients with diabetes (mean age 52 years, 56 % men) underwent cardiovascular risk assessment including multi-slice computed tomography (for non-invasive coronary angiography, from which DTA atherosclerosis can be derived), non-invasive assessment of arterial stiffness with applanation tonometry and assessment of renal function. Measurements of DTA atherosclerosis included assessment of DTA thickening and calcium score. Arterial stiffness was determined by the carotid-femoral pulse wave velocity (PWV), parameters of CKD included estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR). DTA atherosclerosis was present in 180 (84 %) patients. Patients with DTA atherosclerosis had increased arterial stiffness, lower eGFR and higher UACR values. After multivariate correction, DTA calcium score was independently associated with PWV (β = 0.18, p = 0.04). Furthermore, both DTA maximal wall thickness and DTA calcium score were independently associated with eGFR (β = −7.37, p < 0.001 and β = −1.99, p < 0.003, respectively), but not with UACR. The increase in arterial stiffness by atherosclerosis seemed to be mediated by arterial calcification, while the DTA calcium score was independently associated with arterial stiffness, but not DTA maximal wall thickness. Furthermore, parameters of CKD in patients with DM had a distinct relationship with DTA atherosclerosis: DTA atherosclerosis was associated with eGFR but not with UACR.

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References

  1. Henry RM, Kostense PJ, Spijkerman AM, Dekker JM, Nijpels G, Heine RJ et al (2003) Arterial stiffness increases with deteriorating glucose tolerance status: the Hoorn Study. Circulation 107:2089–2095

    Article  PubMed  Google Scholar 

  2. Laakso M (2010) Cardiovascular disease in type 2 diabetes from population to man to mechanisms: the Kelly West Award Lecture 2008. Diabetes Care 33:442–449

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Parving HH, Lewis JB, Ravid M, Remuzzi G, Hunsicker LG (2006) Prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int 69:2057–2063

    Article  PubMed  Google Scholar 

  4. Brandts A, Westenberg JJ, van Elderen SG, Kroft LJ, Roes SD, Tamsma JT et al (2013) Site-specific coupling between vascular wall thickness and function: an observational MRI study of vessel wall thickening and stiffening in hypertension. Invest Radiol 48:86–91

    Article  CAS  PubMed  Google Scholar 

  5. Virmani R, Avolio AP, Mergner WJ, Robinowitz M, Herderick EE, Cornhill JF et al (1991) Effect of aging on aortic morphology in populations with high and low prevalence of hypertension and atherosclerosis. Comparison between occidental and Chinese communities. Am J Pathol 139:1119–1129

    CAS  PubMed Central  PubMed  Google Scholar 

  6. Cecelja M, Hussain T, Greil G, Botnar R, Preston R, Moayyeri A et al (2013) Multimodality imaging of subclinical aortic atherosclerosis: relation of aortic stiffness to calcification and plaque in female twins. Hypertension 61:609–614

    Article  CAS  PubMed  Google Scholar 

  7. McEniery CM, McDonnell BJ, So A, Aitken S, Bolton CE, Munnery M et al (2009) Aortic calcification is associated with aortic stiffness and isolated systolic hypertension in healthy individuals. Hypertension 53:524–531

    Article  CAS  PubMed  Google Scholar 

  8. Sekikawa A, Shin C, Curb JD, Barinas-Mitchell E, Masaki K, El-Saed A et al (2012) Aortic stiffness and calcification in men in a population-based international study. Atherosclerosis 222:473–477

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Molitch ME, DeFronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH et al (2004) Nephropathy in diabetes. Diabetes Care 27(Suppl 1):S79–S83

    PubMed  Google Scholar 

  10. American Diabetes Association (2009) Standards of medical care in diabetes–2009. Diabetes Care 32(Suppl 1):S13–S61

    Article  PubMed Central  Google Scholar 

  11. Djaberi R, Schuijf JD, Boersma E, Kroft LJ, Pereira AM, Romijn JA et al (2009) Differences in atherosclerotic plaque burden and morphology between type 1 and 2 diabetes as assessed by multislice computed tomography. Diabetes Care 32:1507–1512

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Gavin JR, Alberti KGMM, Davidson MB, DeFronzo RA, Drash A, Gabbe SG et al (2003) Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 26(Suppl 1):S5–S20

  13. Rose G, McCartney P, Reid DD (1977) Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prev Soc Med 31:42–48

    CAS  PubMed Central  PubMed  Google Scholar 

  14. de Graaf FR, Schuijf JD, van Velzen JE, Kroft LJ, de Roos A, Reiber JH et al (2010) Diagnostic accuracy of 320-row multidetector computed tomography coronary angiography in the non-invasive evaluation of significant coronary artery disease. Eur Heart J 31:1908–1915

    Article  PubMed  Google Scholar 

  15. Schuijf JD, Pundziute G, Jukema JW, Lamb HJ, van der Hoeven BL, de Roos A et al (2006) Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease. Am J Cardiol 98:145–148

    Article  PubMed  Google Scholar 

  16. Roos CJ, Witkowska AJ, de Graaf MA, Veltman CE, Delgado V, de Grooth GJ et al. (2013) Association of atherosclerosis in the descending thoracic aorta with coronary artery disease on multi detector row computed tomography coronary angiography in patients with suspected coronary artery disease. Int J Cardiovasc Imaging 29:1829–1837

  17. Takasu J, Mao S, Budoff MJ (2003) Aortic atherosclerosis detected with electron-beam CT as a predictor of obstructive coronary artery disease. Acad Radiol 10:631–637

    Article  PubMed  Google Scholar 

  18. Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605

    Article  PubMed  Google Scholar 

  19. Wilkinson IB, Fuchs SA, Jansen IM, Spratt JC, Murray GD, Cockcroft JR et al (1998) Reproducibility of pulse wave velocity and augmentation index measured by pulse wave analysis. J Hypertens 16:2079–2084

    Article  CAS  PubMed  Google Scholar 

  20. Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ (2000) The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 525(Pt 1):263–270

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S et al (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254

    Article  CAS  PubMed  Google Scholar 

  22. Kalsch H, Lehmann N, Mohlenkamp S, Hammer C, Mahabadi AA, Moebus S et al (2013) Prevalence of thoracic aortic calcification and its relationship to cardiovascular risk factors and coronary calcification in an unselected population-based cohort: the Heinz Nixdorf Recall Study. Int J Cardiovasc Imaging 29:207–216

    Article  PubMed  Google Scholar 

  23. Takasu J, Katz R, Nasir K, Carr JJ, Wong N, Detrano R et al (2008) Relationships of thoracic aortic wall calcification to cardiovascular risk factors: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J 155:765–771

    Article  PubMed Central  PubMed  Google Scholar 

  24. Desai MY, Kwon DH, Nair D, Mankad SV, Popovic Z, DeCastro S et al (2008) Association of aortic atherosclerosis and renal dysfunction. J Am Soc Echocardiogr 21:751–755

    Article  PubMed  Google Scholar 

  25. Haruki N, Takeuchi M, Kaku K, Yoshitani H, Tamura M, Abe H et al (2010) Prevalence and clinical implication of complex atherosclerotic plaque in the descending thoracic aorta of Japanese patients assessed by transesophageal echocardiography. Circ J 74:2627–2632

    Article  PubMed  Google Scholar 

  26. Momiyama Y, Ohmori R, Fayad ZA, Tanaka N, Kato R, Taniguchi H et al (2012) Association between kidney dysfuction and the severity of coronary and aortic atherosclerosis. Atherosclerosis 223:523–526

    Article  CAS  PubMed  Google Scholar 

  27. Kim WY, Astrup AS, Stuber M, Tarnow L, Falk E, Botnar RM et al (2007) Subclinical coronary and aortic atherosclerosis detected by magnetic resonance imaging in type 1 diabetes with and without diabetic nephropathy. Circulation 115:228–235

    Article  PubMed  Google Scholar 

  28. Kweon SS, Shin MH, Lee YH, Choi JS, Nam HS, Park KS et al (2012) Higher normal ranges of urine albumin-to-creatinine ratio are independently associated with carotid intima-media thickness. Cardiovasc Diabetol 11:112

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Choi SW, Yun WJ, Kim HY, Lee YH, Kweon SS, Rhee JA et al (2010) Association between albuminuria, carotid atherosclerosis, arterial stiffness, and peripheral arterial disease in Korean type 2 diabetic patients. Kidney Blood Press Res 33:111–118

    Article  CAS  PubMed  Google Scholar 

  30. Shin DI, Seung KB, Yoon HE, Hwang BH, Seo SM, Shin SJ et al (2013) Microalbuminuria is Independently Associated with Arterial Stiffness and Vascular Inflammation but not with Carotid Intima-Media Thickness in Patients with Newly Diagnosed Type 2 Diabetes or Essential Hypertension. J Korean Med Sci 28:252–260

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The department of Cardiology received research grants from Biotronik (Berlin, Germany), Lantheus (North Billerica, Massachusetts), Boston Scientific (Natick, Massachusetts), Edwards Lifesciences (Irvine, California), GE Healthcare (Buckinghamshire, United Kingdom), Medtronic (Minneapolis, Minnesota) and St. Jude Medical (St. Paul, Minnesota). V. Delgado received consulting fees from St. Jude Medical and Medtronic. J. Wouter Jukema received research grants from and was speaker on (CME accredited) meetings sponsored by Astellas, Astra-Zeneca, Biotronik, Boston Scientific, Daiichi Sankyo, Lilly, Genzyme, Medtronic, Merck-Schering-Plough, Pfizer, Orbus Neich, Novartis, Roche, Servier, Sanofi Aventis, the Netherlands Heart Foundation, the Interuniversity Cardiology Institute of the Netherlands and the European Community Framework KP7 Programme.

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Authors and Affiliations

  1. Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands

    Cornelis J. Roos, V. Delgado, J. Wouter Jukema, Jeroen J. Bax & Arthur J. Scholte

  2. The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands

    Cornelis J. Roos & J. Wouter Jukema

  3. Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands

    Eelco J. de Koning & Ton J. Rabelink

  4. Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands

    Eelco J. de Koning

Authors
  1. Cornelis J. Roos
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  2. V. Delgado
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  3. Eelco J. de Koning
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  4. Ton J. Rabelink
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  5. J. Wouter Jukema
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  6. Jeroen J. Bax
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  7. Arthur J. Scholte
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Correspondence to Cornelis J. Roos.

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Roos, C.J., Delgado, V., de Koning, E.J. et al. Associations of atherosclerosis in the descending thoracic aorta on CTA with arterial stiffness and chronic kidney disease in asymptomatic patients with diabetes mellitus. Int J Cardiovasc Imaging 30, 1151–1159 (2014). https://doi.org/10.1007/s10554-014-0441-9

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  • DOI: https://doi.org/10.1007/s10554-014-0441-9

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