Influence Of Abnormal Glucose Metabolism On Vascular Function And Structure In Patients With Coronary Heart Disease

Objectives: The present study was to investigate the impact of thedifferent glycemic status on vascular function and structure in patients withcoronary heart disease, and to compare the clinical implication of the threecommonly used non-invasive testing for evaluation of vascular function andstructure.Methods:242patients with coronary heart disease were divided into threegroups according to OGTT: normal glucose tolerance (NGT, n=76), impairedglucose tolerance (IGT, n=95), type-2diabetes mellitus (DM, n=71). Pulsewave velocity (PWV), intima-media thickness of the common carotid artery(IMT) and systolic central artery pressure (sCAP) were estimatedsimultaneously and SYNTAX score was calculated for evaluation of theseverity of coronary artery disease.Results: There was no significant difference among the three groups inthe major clinical characteristics. As compared to NGT group, higher values ofPWV (p<0.001) were observed respectively in IGT and DM group, with nodifferences of PWV between IGT and DM group. As compared to NGT group,there was no difference of IMT in NGT and DM group, with higher values ofIMT (p<0.01) between NGT and DM group. There was no significant differenceof sCAP measurements among the three groups. As compared to NGT group, higher values of syntax score (p<0.01) were observed respectively in IGT andDM group, with significant difference of SYNTAX score between IGT and DMgroup. Syntax score was highly correlated with PMV (r=0.132, p<0.001) butwas not with IMT or sCAP. The Linear regression found that2h post-loadglucose was correlated highly with PWV (r=0.214, p<0.001) and IMT (r=0.089,p<0.001), lowly with sCAP (r=0.031, p=0.014). The multiple linear regressionanalysis showed that age (beta=0.42, p<0.001),2h post-load glucose(beta=0.33, p<0.001), systolic blood pressure (beta=0.42, p<0.001), and heartrate (beta=0.20, p=0.0033)were found independently related to PWV; age(beta=0.23, p=0.044) and2-h postload glucose (beta=0.35, p=0.009) to IMT;systolic blood pressure (beta=0.70, p<0.001), AIp75(beta=0.25, p<0.001) anddiastole blood pressure (beta=0.12, p<0.001) to sCAP.Conclusions: Abnormal glucose metabolisms, even if at the stage ofimpaired glucose tolerance, promote injuries of vascular function and structurein patients with coronary heart disease. Only PWV is associated with syntaxscore and is superior to IMT or sCAP for identification of vascular functionaland structural abnormalities. Glucose abnormal metabolism is one of the majordeterminants of vascular function and structure.