Vergleich der Gefäßfunktion von Patienten mit Hypercholesterinämie und Diabetes mellitus Typ 2
Creators: name: Drechsel, Lisa
Publisher: name: Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU)
Year: 2023

description: 2. Abstract 2.1 Background This paper focuses on vascular function as a parameter for assessment of cardiovascular risk for patients with diabetes mellitus type 2 and hypercholesterolemia. In the current analysis two groups consisting of patients who either suffer of diabetes mellitus type 2 or hypercholesterolemia were compared. Baseline data were collected before participants were included in different clinical studies. In addition to the leading diagnosis diabetes mellitus type 2 or hypercholesterolemia, many patients suffer of comorbidities like arterial hypertension and various cardiovascular disorders. For realistic estimation of the patients` overall risk to develop cardiovascular diseases or to suffer a cardiovascular event like a stroke or a cardiac infarction, it is necessary to consider the entire health condition and all factors that influence vascular function. Our intention was to approximate the more realistic estimation of individual cardiovascular risk by taking into account the primary disease diabetes mellitus type 2 or hypercholesterolemia in conjunction with present comorbidities. Against the background of a plethora of people bearing an increased risk of developing cardiovascular diseases or already suffering from them, we hope we can make a positive contribution to prevention, early diagnosis and treatment of cardiovascular diseases with this project. 2.2 Patients and methods Baseline data of participants of the prospective, randomized controlled parallel-arm study “Combination of empagliflozin and linagliptin improves blood pressure and vascular function in type 2 diabetes” (Eudra-CT-Nummer: 2016-000242-57) were compared to baseline data of participants of the “Randomized, double-blind, placebo controlled parallel-group, prospective clinical study to analyse the effect of evolocumab on vascular function “(Eudra-CT-Nummer: 2017-004129-33). Both studies were carried out in the clinical research centre (CRC) of the Department of Nephrology and Hypertensiology at University hospital Erlangen. Only participants who either suffer from diabetes mellitus type 2 or hypercholesterolemia were included in the study. Therefore, persons who took part in the diabetes study, but also had the diagnosis hypercholesterolemia, were excluded. Likewise, patients with the diagnosis of diabetes mellitus type 2, who were included in the hypercholesterolemia study, were filtered out of this project. According to that, 52 persons with diabetes mellitus type 2 finally were compared to 42 patients with hypercholesterolemia. To capture the vascular function, we 5 conducted a pulse wave analysis by the SphygmoCor XCEL system (Atcor Medical, Sydney, Australia). This device allows the generation of an aortal pulse wave, which gives important information about the central vascular elasticity. Central systolic blood pressure (cSBP), central diastolic blood pressure (cDBP), central pulse pressure (cPP), central augmentation pressure (cAP), central augmentation index (cAlx), as well as central augmentation index normalized to 75 beats per minute (cAlx@75) plus forward-, and backward wave amplitude are essential parameters that can be derived from pulse wave analysis. Furthermore, the device Mobil-O-Graph, IEM Stolberg, Germany was used. This tool provides the opportunity to determine the central and brachial systolic and diastolic blood pressure (c)sBP/ (c)dBP [mmHg] at frequent intervals within the framework of 24-hour measurements under everyday life conditions. Besides one gets additional information about the mean arterial pressure MAP [mmHg], the pulse pressure PP [mmHg], the pulse wave velocity PWV [m/s], the heart rate [Schläge/Min] and the augmentation index Alx [%] under daily life conditions. Several pulse waves must be recorded to form an average pulse wave that allows us to calculate the aortic central wave. 2.3 Results Starting with information about properties of the study population we recognize the average age of the diabetes mellitus type 2 group differs with 57 ± 10 years from the average age of the hypercholesterolemia group with 65 ± 8 years. There are also significant differences in the mean systolic blood pressure, which amounts to 135,8 ± 11,6 mmHg in the diabetes group and 124,2 ± 14,8 mmHg in the hypercholesterolemia group as well as in the mean diastolic blood pressure, which is 83,2 ± 10,2 mmHg in the cohort of diabetes and 74,9 ± 9,4 mmHg in the cohort of hypercholesterolemia. Heart rate was higher in patients with diabetes mellitus type 2 (74,3 ± 11,3 beats per minute) than in patients with hypercholesterolemia (64,2 ± 11,4 beats per minute). The diabetes group showed an average plasma glucose value of 164,4 ± 31,7 mg/dl and an HbA1c value of 7,8 ± 0,8 %, while the hypercholesterolemia group had a plasma glucose value of 99,9 ± 11,6 mg/dl and an HbA1c value of 5,7 ± 0,3 %. The glomerular filtration rate of patients with diabetes was lower (59,9 ± 0,4 ml/min) compared to participants with hypercholesterolemia (77,4 ± 14,8 ml/min). There are further differences between the lipid metabolism parameters of the two groups with respect to triglycerides (199,6 ± 102,4 mg/dl in DM 2 and 103,9 ± 41,3 mg/dl in hypercholesterolemia), total cholesterol (212,4 ± 35,0 mg/dl in DM 2 and 161,8 ± 21,7 mg/dl in hypercholesterolemia.), as well as HDL cholesterol (45,2 ± 9,7 mg/dl in DM 2 and 50,0 ± 11,2 mg/dl in hypercholesterolemia) and LDL cholesterol (142,4 ± 26,6 mg/dl in DM 2 and 97,3 ± 16,0 mg/dl in hypercholesterolemia). Significant differences were found in the pulse wave amplitude for the forward pulse wave (31,7 ± 4,9 mmHg in DM 2 compared to 26,8 ± 6,2 mmHg in hypercholesterolemia), which were collected by the SphygmoCor XCEL system. Considering the results obtained by the Mobil-O-Graph system, significant differences were found in the systolic (131,1 ± 9,3 mmHg in DM 2 and 120,7 ± 12,6 6 mmHg in hypercholesterolemia) and diastolic blood pressure (82,8 ± 7,1 mmHg in DM 2 and 75,3 ± 8,2 mmHg in hypercholesterolemia) as well as in the mean arterial pressure (104,7 ± 6,6 mmHg in DM 2 and 96,0 ± 9,2 mmHg in hypercholesterolemia). The central diastolic blood pressure was 84,4 ± 7,0 mmHg for patients with diabetes and 76,5 ± 8,9 mmHg for patients with hypercholesterolemia. Ambulatory pulse wave velocity was 8,6 ± 1,4 m/s in participants with diabetes, while it was higher in the comparison group (9,2 ± 1,3 m/s). 24-hour ambulatory heart rate was higher (79,0 ± 10,3 beats per minute) in the diabetes group than in the hypercholesterolemia group (68,2 ± 10,3 beats per minute). The central augmentation index normalized to 75 beats per minute was found to be 26,0 ± 5,1 % in patients with diabetes and 22,8 ± 6,8 % in the comparison cohort. In addition to diabetes mellitus type 2 and hypercholesterolemia, respectively, the following comorbidities were found: 24 of 52 patients with diabetes mellitus type 2 suffered from hypertension, one patient had a history of stroke, and one patient had the diagnosis of coronary heart disease. In the comparison group with hypercholesterolemia, 37 of 42 persons suffered from coronary heart disease, 36 patients had the diagnosis hypertension, 11 participants already had a history of stroke, one patient suffered from chronic kidney disease and two patients had the diagnosis of a peripheral vascular disease. 2.4 Conclusion The results of this study allow the conclusion that both examined groups have impaired vascular function. Signs of reduced vascular elasticity in the diabetes group were the increased central diastolic blood pressure and the increased augmentation index normalized to 75 beats per minute (cAlx@75). The hypercholesterolemia cohort showed a significantly increased pulse wave velocity as a marker of pathological changes of the blood vessel structure. A core aspect of this paper is to assess the results in the interplay between main diagnosis and respective comorbidities. While hypertension is the most common comorbidity for patients with diabetes mellitus type 2, it is accompanied by coronary heart disease as a leading diagnosis for persons who suffer from hypercholesterolemia. The high prevalence of cardiovascular diseases in the population makes it necessary to assess the vascular status of persons concerned to evaluate the individual cardiovascular risk.