The Relationship Between HbA_1C,Carotid Plaque And Pulse Wave Velocity In Elderly Patients With Diabetes

Background and Objective:The prevalence of type 2 diabetes mellitus of elderly patients in recent years shows a rapid upward trend,which has become a serious public health problem that threatens health and quality of life of the elderly.The risk of arteriosclerosis in patients with diabetes mellitus was significantly higher than that of non-diabetic patients.It is important to study the risk factors of arteriosclerosis in patients with diabetes mellitus to prevent cardiovascular complications.Carotid artery is an important medium artery in the human body,the occurrence of atherosclerosis is a medium to infer the systemic atherosclerosis.Pulse wave velocity is a noninvasive assessment of arterial function.It is a classical index that reflect compliance and stiffness of the body aorta,main artery and medium artery.Pulse wave velocity was found to be independent predictors of risk of cardiovascular events and prognosis.In this study,we measured the indexes of HbAIC,blood glucose,blood pressure,blood lipid,carotid intima-media thickness,plaque score,plaque stability and pulse wave velocity.By exploring the correlation of HbAIC levels with carotid atherosclerotic plaque and pulse wave velocity in elderly patients,we aimed to provide a basis for prevention of arteriosclerosis in elderly patients with diabetes.Methods:In this study,we enrolled elderly outpatients and inpatients with type 2 diabetes mellitus in the Qilu Hospital of Shandong University from July 2015 to March 2016.All of the patients are in line with WHO diagnostic criteria for type 2 diabetes mellitus,1999.The patients with cancer and blood diseases,severe liver and kidney dysfunction,acute infection or other acute diseases,recent acute myocardial infarction,heart failure or stroke,physical impairment or cognitive dysfunction were excluded.There were 130 cases of elderly patients with diabetes mellitus,aged from 60 to 92 years old,with an average age of 72.03 8±8.79,of whom there were male 59 cases.All of the subjects were asked about the medical history and accepted a physical examination.Gender,age,past history and other general data were recorded,and height,body weight,blood pressure were measured.Fasting blood glucose,HbA1C,triglyceride,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol and other indexes were determined.Carotid artery ultrasound was performed.Observe and record the location,size,echo of the carotid artery,measure the carotid intima-media thickness.Plaque scores were calculated according to the Crouse carotid plaque scoring criteria.The carotid plaques were classified according to the echo of the plaque.The detection and recording of brachial ankle pulse wave velocity were performed by using automatic arteriosclerosis detector.All of the subjects were divided into 3 groups according to the HbA1C levels:low level group(A group,HbA1C<7%,n=49);middle level group(B group,7%?HbA1C<8.5%,n=58);high level group(C group,HbA1C?8.5%,n=23).Statistical analysis was performed using SPSS20.0 software.Results:1.Among low level group,middle level group and high level group,systolic blood pressure,fasting blood glucose,high density lipoprotein cholesterol,carotid intima-media thickness,plaque score,plaque stability,pulse wave velocity had significant difference.2.Compared with the low level group,systolic blood pressure,fasting blood glucose,carotid intima-media thickness,plaque score,unstable plaque ratio and pulse wave velocity were higher in middle level group,while high density lipoprotein cholesterol is lower in middle level group;body mass index,systolic blood pressure,fasting blood glucose,carotid intima-media thickness,plaque score,unstable plaque ratio and pulse wave velocity in high level group were higher than in low level group,high density lipoprotein cholesterol is lower than low level group;compared with the middle level group,fasting blood glucose,carotid intima-media thickness,plaque score and unstable plaque ratio in high level group were higher than those in the middle level group.3.Correlation analysis showed that carotid artery intima-media thickness levels had correlation with gender(r=0.389,P<0.01),age(r=0.296,P<0.01),fasting blood glucose(r=0.203,P<0.05),HbA1C(r=0.405,P<0.01)and high density lipoprotein cholesterol(r=-0.208,P<0.05);carotid artery plaque score correlated with gender(r=0.321,P<0.01),age(r=0.355,P<0.01),HbA1C(r=0.340,P<0.01)and high density lipoprotein cholesterol(r=-0.249,P<0.01);there is a correlation between the stability of carotid plaques with body mass index(r=-0.286,P<0.01),systolic blood pressure(r=-0.188,P<0.05),HbA1C(r=-0.368,P<0.01)and high density lipoprotein cholesterol(r=0.405,P<0.01);pulse wave velocity was correlated with age(r=0.516,P<0.01),systolic blood pressure(r=0.521,P<0.01),diastolic blood pressure(r=0.225,P<0.01),fasting blood glucose(r=0.181,P<0.05),HbA1C(r=0.229,P<0.01),triglyceride(r=-0.253,P<0.01),total cholesterol(r=-0.311,P<0.01)and low density lipoprotein cholesterol(r=-0.244,P<0.01).4.Logistic regression analysis showed that gender,age and HbA1C is independently associated with carotid intima-media thickness in elderly diabetic patients;gender,age,body mass index and HbA1C is independently associated with carotid atherosclerosis plaque score;age,HbA1C,high density lipoprotein cholesterol is independently associated with the stability of carotid atherosclerotic plaque;age,systolic blood pressure is independently associated with pulse wave velocity.5.There was a significant correlation between carotid intima-media thickness and pulse wave velocity(r=0.234,P<0.01).Plaque score and plaque stability were not correlated with pulse wave velocity.Conclusions:1.HbA1C levels in elderly patients with diabetes mellitus were positively related to carotid intima-media thickness,plaque score,unstable plaque ratio,and pulse wave velocity.HbA1C is an independent risk factor for carotid intima-media thickness,plaque score,and increased proportion of unstable plaques.Controlling HbA1C at a reasonable level is beneficial to delaying the occurrence and development of arteriosclerosis in elderly diabetic patients.2.Carotid intima-media thickness was positively correlated with pulse wave velocity in elderly diabetic patients.Performing carotid ultrasound and pulse wave velocity examinations simultaneously can early assess arteriosclerosis which to provide evidence for early intervention and treatment.3.HbA1C,systolic blood pressure,high density lipoprotein cholesterol and body mass index are independent risk factors for arteriosclerosis in elderly diabetics.Comprehensive control of blood glucose,blood pressure,blood lipids and body weight can help to delay the progression of arteriosclerotic lesions in elderly diabetic patients.Background and Objective:Obesity is a major risk factor for a variety of metabolic diseases and some tumors.As the body mass index increases,the risk of diabetes increases.Most people with diabetes are overweight or obese.The coexistence of obesity and diabetes can aggravate the metabolic disorder and increase the risk of cardiovascular disease.At present,the common indexes for evaluating obesity are body mass index,waist circumference,waist to hip ratio,waist to height ratio.Pulse wave velocity is a noninvasive assessment of arterial function.It is a classical index that reflect compliance and stiffness of the body aorta,main artery and medium artery.Pulse wave velocity was found to be independent predictors of risk of cardiovascular events and prognosis.This study uses brachial ankle artery pulse wave velocity as the evaluation of patients with arteriosclerosis.By exploring the influence of body mass index,waist circumference,waist to hip ratio and waist height ratio on pulse wave velocity in type 2 diabetes mellitus patients,we aimed to provide a basis for the prevention of atherosclerosis in patients with diabetes mellitus.Methods:In this study,we enrolled outpatients and inpatients with type 2 diabetes mellitus in the Qilu Hospital of Shandong University from July 2015 to March 2016.All of the patients are in line with WHO diagnostic criteria for type 2 diabetes mellitus,1999.The patients with cancer and blood diseases,severe liver and kidney dysfunction,acute infection or other acute diseases,recent acute myocardial infarction,heart failure or stroke,physical impairment or cognitive dysfunction were excluded.There were 136 cases of patients with diabetes mellitus,aged from 45 to 87 years old,with an average age of 67.40±10.33,of whom there were male 61 cases.All of the subjects were asked about the medical history and accepted a physical examination.Gender,age,past history and other general data were recorded,height,body weight,waist circumference,hip circumference,blood pressure were measured,the body mass index,waist to hip ratio,waist to height ratio were calculated.Fasting blood glucose,HbA1C,triglyceride,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol and other indexes were determined.The detection and recording of brachial ankle pulse wave velocity were performed by using automatic arteriosclerosis detector.The pulse wave velocities in different groups were analyzed according to different obesity criteria.Statistical analysis was performed using SPSS 20.0 software.Results:1.The height,weight,waist circumference,waist to hip ratio of male subjects were higher than that of female,and high density lipoprotein cholesterol was lower than that of female.2.The pulse wave velocity in obese group was higher than that in non obese group according to waist circumference,waist to hip ratio,waist to height ratio.According to the body mass index group,the pulse wave velocity of the normal weight group,overweight group and obesity group increased gradually,and the difference between the three groups was statistically significant3.Correlation analysis with age controlled showed that pulse wave velocity of male was correlated with waist circumference(r=0.333,P<0.01)and waist to height ratio(r=0.290,P<0.05);pulse wave velocity of female was significantly correlated with waist circumference(r=0.449,P<0.01),waist to hip ratio(r=0.397,P<0.01),waist to height ratio(r=0.459,P<0.01)and body mass index(r=0.302,P<0.01).4.Logistic regression analysis showed that waist to hip ratio and waist to height ratio are independently related to the increase in pulse wave velocity.Conclusions:Pulse wave velocity in obese patients with type 2 diabetes is higher than in non obese patients.Waist to hip ratio and waist to height ratio were independent risk factors of arterial elasticity.Obesity assessment and effective intervention of type 2 diabetes mellitus can control the development of atherosclerosis to a certain extent.