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Noninvasive assessment of subclinical atherosclerosis in normotensive gravidae with gestational diabetes

Nichtinvasive Untersuchung subklinischer Atherosklerose bei normotensiven Schwangeren mit Gestationsdiabetes

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Abstract

Aim

Carotid artery intima-media thickness (CIMT), hyperhomocysteinemia, microalbuminuria, and nitric oxide reflect subclinical atherosclerosis and predict the risk of future cardiovascular events. We aimed to evaluate the presence of subclinical atherosclerosis and endothelial dysfunction in normotensive patients with gestational diabetes mellitus (GDM) noninvasively.

Patients and methods

We enrolled 41 normotensive patients with GDM and 44 healthy gravidae in the study. Serum homocysteine and nitric oxide levels, urinary albumin excretion (microalbuminuria), and CIMT were evaluated along with lipid parameters and anthropometric measurements.

Results

Patients with GDM had significantly higher levels of serum homocysteine, urinary albumin excretion, and increased CIMT (p < 0.001, p=0.005, and p < 0.001, respectively). Nitric oxide levels were significantly reduced in the patient group (p < 0.001). There was a significant difference between groups in terms of low-density lipoprotein (LDL) but not of high-density lipoprotein (HDL) and triglyceride levels. A significant correlation was observed between CIMT and serum LDL, HDL, homocysteine, nitric oxide levels, and urinary albumin excretion. Microalbuminuria was significantly correlated with serum homocysteine levels (p=0.03) but not with nitric oxide.

Conclusion

Independent of elevated blood pressure, subclinical atherosclerosis and endothelial dysfunction exist in normotensive patients with GDM. Further studies with a large number of participants are required to clarify these data.

Zusammenfassung

Ziel

Karotis-Intima-Media-Dicke, Hyperhomozysteinämie, Mikroalbuminurie und Stickoxid (NO) sind Zeichen einer subklinischen Atherosklerose und Prädiktoren des Risikos für zukünftige kardiovaskuläre Ereignisse. Ziel der vorliegenden Studie war es, subklinische Atherosklerose und endotheliale Dysfunktion bei normotensiven Patientinnen mit Gestationsdiabetes (GDM) nichtinvasiv zu untersuchen.

Patienten und Methoden

In die Studie wurden 41 normotensive Patientinnen mit GDM und 44 gesunde Schwangere aufgenommen. Serumhomozystein- und -NO-Wert, Albuminausscheidung im Urin (Mikroalbuminurie) und Karotis-Intima-Media-Dicke (CIMT) wurden neben Lipidwerten und anthropometrischen Parametern bestimmt.

Ergebnisse

Patientinnen mit GDM wiesen signifikant höhere Werte für Serumhomozystein, Albuminausscheidung im Urin und eine erhöhte CIMT auf (p < 0,001; p=0,005 bzw. p < 0,001). Die NO-Werte waren in der Patientengruppe signifikant vermindert (p < 0,001). Es bestand ein signifikanter Unterschied zwischen den Gruppen hinsichtlich LDL, nicht aber für HDL und Triglyzeride. Eine signifikante Korrelation wurde zwischen CIMT und den Werten für Serum-LDL, -HDL, -homozystein, -NO sowie Albuminausscheidung im Urin festgestellt. Eine Mikroalbuminurie war in signifikanter Weise mit den Serumhomozysteinwerten korreliert (p=0,03), nicht aber mit NO.

Fazit

Auch ohne erhöhten Blutdruck bestehen bei normotensiven Patientinnen mit GDM eine subklinische Atherosklerose und endotheliale Dysfunktion. Weitere Studien mit einer großen Teilnehmerzahl sind zur Klärung der vorliegenden Daten erforderlich.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Faculty of Medicine, Yuzuncu Yil University, 65080, Van, Turkey

    A.E. Atay MD, H. Simsek MD, B. Demir MD, M.N. Sakar MD, M. Kaya MD, S. Pasa MD, S. Demir MD & D. Sit MD

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  1. A.E. Atay MD
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  2. H. Simsek MD
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  3. B. Demir MD
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Atay, A., Simsek, H., Demir, B. et al. Noninvasive assessment of subclinical atherosclerosis in normotensive gravidae with gestational diabetes. Herz 39, 627–632 (2014). https://doi.org/10.1007/s00059-013-3874-3

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