ECE2009 Poster Presentations Diabetes and Cardiovascular (103 abstracts)
The relationship between hemoglobin levels and endothelial functions in diabetes mellitus
Alper Sonmez 1 , M Ilker Yilmaz 2 , Carmine Zoccali 3 , Mutlu Saglam 4 , Selim Kilic 5 , Gokhan Uckaya 1 , Tayfun Eyileten 2 , Mujdat Yenicesu 2 & Mustafa Kutlu 1
1Department of Endocrinology and Metabolism, Gulhane Military Medical School, Etlik, Ankara, Turkey; 2Department of Nephrology, Gulhane Military Medical School, Etlik, Ankara, Turkey; 3Nephrology, Dialysis and Transplantation Unit and CNR-IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy; 4Department of Radiology, Gulhane Military Medical School, Etlik, Ankara, Turkey; 5Department of Epidemiology, Gulhane Military Medical School, Etlik, Ankara, Turkey.
Introduction: Hemoglobin (Hb) is the main carrier and buffer of Nitric oxide. Recently, an inverse association between Hb and the endothelium dependent relaxation was observed in patients with Type 2 diabetes. Testing whether this association exists also in diabetic nephropathy is important because anemia in these patients starts at an earlier stage than in other renal disease. Also, at population level diabetes and renal dysfunction, particularly albuminuria, contribute independently to the risk of cardiovascular complications. Therefore, we investigated the association between Hb and the forearm blood flow mediated vasodilatory response to ischemia (FMD) in a group of well selected patients with diabetic nephropathy.
Methods: We enrolled 89 diabetics with proteinura who were normotensive, non-obese, non-smoker, non dyslipidemic and cardiovascular events free. None of the patients were taking metformin or drugs that interfere with the renin–angiotensin system. FMD of the brachial artery was assessed by high resolution ultrasound.
Results: The age, sex, BMI, blood pressure, HbA1c and glomerular filtration rates (GFR) were similar in patients having Hb values either above or below the median Hb values. In the multivariate analysis, higher Hb levels were associated with significantly lower FMD values (β=−0.44, P<0.001). Adjustment for the full set of Framingham risk factors and further adjustment for proteinuria, hsCRP, insulin, GFR and the uric acid levels did not produce a significant reduction in the strength of the association between Hb and FMD.
Discussion: According to the results diabetic nephropathy patients with higher Hb values have impaired endothelial functions independent from any other established cardiovascular risk factor. Our findings show that frank proteinuria exposes a situation wherein Hb may limit the endothelium-mediated vasoregulation in type-2 diabetes. Further studies are warranted in order to see whether these findings may explain the mechanism of increased cardiovascular event rates in patients with diabetes mellitus and diabetic proteinuria.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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