Arterial stiffness is an extremely good predictor of future type 2 diabetes, regardless of blood pressure. However, patients who have stiff arteries and high blood pressure are at the highest risk of diabetes, as demonstrated in an investigation of more than 11,000 people in China.
For Xue Tian, MD, study author and member of the neurology department at the Beijing Tiantan Hospital, China, the study unveils new options for diabetes prevention. “Identifying people at high risk of developing diabetes is clinically relevant because early intervention can prevent disease onset and delay its progression,” the authors write in hypertension.
Earlier studies demonstrated that high blood pressure is a risk factor for type 2 diabetes. “It was surprising at first that arterial stiffness is such a good predictor for type 2 diabetes,” said Peter Schwarz, MD, first chair of the working group on prevention of the German Diabetes Association. “However, type 2 diabetes is often preceded by many years of insulin resistance — and insulin is a highly potent growth factor, which also promotes the formation of atherosclerotic plaque.”
For the current investigation, researchers analyzed data from 11,156 participants in the KaiLuan study. More than 100,000 employees of the coal and chemical company KaiLuan, in Tangshan, China, have been monitored since 2006 in this prospective study. Blood pressure and fasting glucose level are measured every 2 years. Since 2010, pulse wave velocity has also been measured; this provides an indication of arterial stiffness.
A Dangerous Combination
By 2017, after a median of 6 years, around 7% of the study participants had developed type 2 diabetes. People with increased arterial stiffness and high blood pressure were at the highest risk of developing type 2 diabetes. Their risk of diabetes was 142% higher than the risk in people with ideal vascular function: no high blood pressure and normal arterial stiffness.
However, even study participants with normal blood pressure had a 111% higher risk of type 2 diabetes if their arteries were stiffer than those of people with ideal vascular function.
Participants with high blood pressure and normal arterial stiffness had the smallest increase in diabetes risk, at 48%.
However, among study participants with normal blood pressure but whose arteries were stiffer, the risk for type 2 diabetes was 111% higher than among those with ideal vascular function.
The smallest increase in diabetes risk, at 48%, was among participants with high blood pressure and normal arterial stiffness.
“It was surprising that people with increased arterial stiffness were more likely to develop type 2 diabetes, regardless of whether or not they had high blood pressure,” said senior author Anxin Wang, MD, also of the Beijing Tiantan Hospital. “This is strong evidence that arterial stiffness is a better predictor for type 2 diabetes than high blood pressure.”
For Schwarz, who leads the clinical department for prevention at the University Hospital Dresden, there is a logical explanation for this finding. “Unlike arterial stiffness, high blood pressure can have a variety of causes, none of which may necessarily have anything to do with insulin resistance,” he told Medscape Medical News. “If high blood pressure and insulin resistance are present, this leads to increased arterial stiffness, and the predictive effect increases.”
On the basis of their results, the authors of the current study conclude that the simultaneous treatment of high blood pressure and arterial stiffness can help to reduce the risk of diabetes. The fact that arterial stiffness proved to be a better predictor of type 2 diabetes than blood pressure also offers “new insights into future strategies for preventing diabetes.”
Uncertain clinical relevance
But Schwarz doubts whether measuring arterial stiffness could be of any value for preventing diabetes in clinical practice. “On the one hand, no one is practicing structured diabetes prevention in our healthcare system. On the other, it is an expensive procedure that will only be performed by certain specialists.”
Schwarz expressed the hope that diabetes prevention in Germany will improve through the use of digital health applications. “You can give the patient an app that will help to practice prevention.” However, a pulse wave velocity measurement is not the ideal parameter. “It would be much easier to determine insulin resistance, and that would only cost €5.”
Illuminating the Pathophysiology
Despite this observation, Schwarz stressed that the investigation from China “is an enormously significant study.” It may not have any direct effect on clinical practice, but it does have great effect on the pathophysiologic understanding of the disease and its metabolic risk factors. This is because “arterial stiffness is a completely logical link in the pathophysiology of type 2 diabetes, but it has not been afforded any attention to date.”
This article was translated from the Medscape English edition.