Augmentation of central arterial pressure as a marker of atherosclerosis in patients with type 2 diabetes

Macrovascular disease is the most common cause of morbidity and mortality in diabetic patients. With the increasing numbers of patients with type 2 diabetes, a simple, noninvasive method is needed to detect atherosclerosis. Augmentation represents the difference between the second and first peaks of the central arterial pressure waveform in systole and is a measure of systemic arterial stiffness, which causes the pressure wave to rebound. We investigated whether augmentation could serve as a marker of atherosclerosis in patients with type 2 diabetes. Central arterial pressure and degree of its augmentation by pulse wave rebound were measured sphygmographically in 208 consecutive patients with type 2 diabetes and 117 healthy control subjects. The relationship between augmentation and carotid atherosclerosis detected by carotid ultrasonography was investigated in a subgroup of 81 diabetic patients. Augmentation was greater in diabetic patients than control subjects (13.2 +/- 6.9 vs. 9.4 +/- 5.7 mm Hg, P < 0.0001). The positive correlation between augmentation and intima-media thickness (r = 0.309, P = 0.0051) and between augmentation and plaque score (r = 0.304, P = 0.0059) were found in patients with type 2 diabetes. Augmentation was greater in diabetic patients with cardiovascular disease (n = 47) than without (n = 161; 15.1 +/- 8.4 vs. 12.6 +/- 6.3 mm Hg, P = 0.031). Augmentation of central arterial pressure is a reliable marker for atherosclerosis in patients with type 2 diabetes. This simple, noninvasive determination would permit large-scale, early screening for atherosclerosis in patients with type 2 diabetes, who are at increased risk for cardiovascular disease. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.