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The systolic–diastolic difference in carotid stiffness is increased in type 2 diabetes: The Maastricht Study

Veugen, Marja G.J.a,b; Henry, Ronald M.A.a,b,c; van Sloten, Thomas T.a,b; Hermeling, Eveliend; Brunner-La Rocca, Hans-Petere; Schram, Miranda T.a,b,c; Dagnelie, Pieter C.b,f,g; Schalkwijk, Casper G.a,b; Kroon, Abraham A.a,b; Stehouwer, Coen D.A.a,b; Reesink, Koen D.b,h

doi: 10.1097/HJH.0000000000001298
ORIGINAL PAPERS: Diabetes mellitus

Objective: In type 2 diabetes (T2D), increased arterial stiffening results from accelerated arterial wall matrix remodeling. The associated structural alterations modify the pressure dependency of arterial stiffness, which can be quantified by the systolic–diastolic difference in carotid pulse wave velocity (δPWV). We evaluated the association between T2D and δPWV as marker for matrix remodeling and whether δPWV may contain additional information beyond carotid stiffness (cPWV).

Methods: In 746 individuals from The Maastricht Study, 415 with normal glucose metabolism; 126 with prediabetes; and 205 with T2D, carotid pulse wave velocity (cPWV) and δPWV were determined by ultrasonography and tonometry. Multiple linear regression analyses were used to investigate associations of glucose metabolism status (with normal glucose metabolism as reference) with cPWV and δPWV, adjusting for age, sex, mean arterial pressure, prior cardiovascular disease, estimated glomerular filtration rate and smoking, and δPWV or cPWV as appropriate.

Results: After adjustment for age, sex, mean arterial pressure, prior cardiovascular disease, estimated glomerular filtration rate and smoking, T2D was associated with greater cPWV [β (95% confidence interval) 0.376 (0.119; 0.632)] and δPWV [0.301 (0.013; 0.589)]. After additional adjustment for δPWV or cPWV, associations of T2D with cPWV and δPWV were attenuated [0.294 (0.048; 0.539) and 0.173 (−0.103; 0.449), respectively]. Prediabetes was not associated with either cPWV or δPWV.

Conclusion: The systolic-diastolic difference in carotid stiffness is increased in T2D, but not prediabetes. Importantly, the association was not abolished by carotid stiffness, which suggests that systolic–diastolic difference in carotid stiffness carries additional information regarding arterial matrix remodeling.

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aDepartment of Internal Medicine, Maastricht University Medical Centre +

bCARIM School for Cardiovascular Diseases, Maastricht University

cHeart and Vascular Centre

dDepartment of Radiology

eDepartment of Cardiology, Maastricht University Medical Centre +

fCAPHRI School for Public Health and Primary Care

gDepartment of Epidemiology, Maastricht University

hDepartment of Biomedical Engineering, Maastricht University Medical Centre +, Maastricht, The Netherlands

Correspondence to Koen D. Reesink, PhD, Department of Biomedical Engineering; CARIM School for Cardiovascular Diseases, Maastricht University, Universiteitssingel 50 (room H3.360), 6229 ER Maastricht, The Netherlands. Tel: +31 43 388 1659; e-mail:

Abbreviations: ρ, blood density; δPWV, systolic–diastolic difference in carotid pulse wave velocity; AGE, advanced glycation endproduct; CEL, Nε-(carboxyethyl)lysine; cfPWV, carotid-to-femoral pulse wave velocity; CML, Nε-(carboxymethyl)lysine; cPWV, carotid pulse wave velocity; CVD, cardiovascular disease; D, diameter; DC, distensibility coefficient; DBP, diastolic blood pressure; eGFR, estimated glomerular filtration rate; HOMA2-IR, homeostasis model assessment 2 for insulin resistance; HR, heart rate; IMT, intima–media thickness; MAP, mean arterial pressure; NGM, normal glucose metabolism; PPcar, local carotid pulse pressure; RAS-inhibitor, renin–angiotensin system inhibitor; SAF, skin autofluorescence; SBP, systolic blood pressure; T2D, type 2 diabetes; ΔD, distension

Received 22 August, 2016

Revised 13 December, 2016

Accepted 18 January, 2017

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