IMPAIRED ENDOTHELIUM-DEPENDENT VASODILATION IN PATIENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

Citation
Mt. Johnstone et al., IMPAIRED ENDOTHELIUM-DEPENDENT VASODILATION IN PATIENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS, Circulation, 88(6), 1993, pp. 2510-2516
Citations number
60
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
ISSN journal
0009-7322
Volume
88
Issue
6
Year of publication
1993
Pages
2510 - 2516
Database
ISI
SICI code
0009-7322(1993)88:6<2510:IEVIPW>2.0.ZU;2-S
Abstract
Background. Endothelium-dependent vasodilation is abnormal in experime ntal models of diabetes mellitus. We postulated that abnormalities of endothelial function are also present in patients with insulin-depende nt diabetes mellitus and may contribute to the pathogenesis of vascula r disease in these individuals. Methods and Results. Vascular reactivi ty was measured in the forearm resistance vessels of 15 patients with insulin-dependent diabetes mellitus and 16 age-matched normal subjects . No patient had hypertension or dyslipidemia. Each subject was pretre ated with aspirin to inhibit endogenous production of prostanoids. Met hacholine chloride (0.3 to 10 mu g/min) was administered via the brach ial artery to assess endothelium-dependent vasodilation. Sodium nitrop russide (0.3 to 10 mu g/min) and verapamil (10 to 300 mu g/min) were i nfused intra-arterially to assess endothelium-independent vasodilation ; phenylephrine (0.3 to 3 mu g/min) was administered to examine vasoco nstrictor responsiveness. Forearm blood flow was determined by venous occlusion plethysmography, and dose-response curves were generated for each drug. Basal forearm blood flow in diabetic and normal subjects w as comparable (2.6+/-0.2 versus 2.1+/-0.3 mL.100 mL(-1).min(-1), respe ctively; P=NS). The forearm vasodilative response to methacholine was less in diabetic than in normal subjects. At the highest dose of metha choline, the forearm blood flow increased 9.5+/-1.1 mL.100 mL(-1).min( -1) in diabetic subjects and 15.3+/-1.4 mL.100 mL(-1).min(-1) in norma l subjects (P<.01). The forearm blood flow responses to nitroprusside and verapamil and the forearm vasoconstricter responses to phenylephri ne were similar in diabetic and healthy subjects. In diabetic subjects , endothelium-dependent vasodilation correlated inversely with serum i nsulin concentration but not with glucose concentration, glycosylated hemoglobin, or duration of diabetes. Conclusions. Endothelium-dependen t vasodilation is abnormal in forearm resistance vessels of patients w ith insulin-dependent diabetes mellitus. This abnormality may be relev ant to the high prevalence of vascular disease that occurs in these in dividuals.