Velocidade da onda de pulso arterial em adultos do Projeto Elsa-Brasil: influência do diabetes e de seus parâmetros laboratoriais de avaliação

Abstract

Cardiovascular diseases (CVDs) are the leading causes of death in developing countries and are expected to be the leading cause of mortality worldwide in the coming years. The prevalence of CVDs practically doubled, from 271 million in 1990 to 523 million in 2019. There are several risk factors associated with the development of CVDs, such as arterial hypertension, diabetes mellitus (DM), obesity, and smoking, among others. Such risk factors for CVDs can alter the structural and functional properties of large arteries, increasing arterial stiffness. Arterial stiffness can be measured through pulse wave velocity (PWV), which can be evaluated in the carotid-femoral segment (cf-PWV), by measuring the total time that the pulse wave takes to travel the distance between the carotid and femoral arteries. DM is directly linked to the increase in the development of CVDs, as it favors the emergence of atherosclerotic lesions of large arteries. However, the association between DM and arterial stiffness is unknown. Within this context, the objective of the present study was to evaluate the cf PWV among diabetic and non-diabetic adults, and the association between cf-PWV and the lab-based criteria involved in the diagnosis of diabetes. In our study, 13,912 individuals aged between 35 and 74 years enrolled in the Longitudinal Study of Adult Health (ELSA-Brasil) were evaluated. Clinical, anthropometric, and laboratory data were performed during a morning visit, and self-reported medical history, medications in regular use, and sociodemographic data were recorded during the interview. Cf-PWV was measured using a validated non-invasive automatic instrument with the device sensor positioned in the carotid and femoral arteries of the participant in the supine position. Diabetes was established by previous medical diagnosis, as well as by the use of hypoglycemic drugs, fasting glucose, oral glucose tolerance test (GTT), or glycated hemoglobin (HbA1c). We found a prevalence of diabetes of 18.7%, higher in men than in women. Diabetes subjects had higher cf-PWV after adjustment for confounders, regardless of sex (men: 9.7 ± 1.7 vs. 9.4 ± 1.7 m/s, P < 0.05; women: 9.4 ± 1.6 vs. 9.1 ± 1.7 m/s, P < 0.05). We also observed a progressive increase in cf-PWV as more than one laboratory criterion for diagnosing diabetes (fasting glucose, HbA1c or glucose 2h post-GTT) was met. Wealsofoundthatdiabeticsubjectswithchanges in any laboratory criteria (fasting glucose, HbA1c or glucose 2h post-GTT) and had higher cf-PWV than participants without diabetes, regardless of sex. Thus, we conclude that diabetes is associated with higher cf-PWV as well as each laboratory parameter used for its diagnosis. Our results address the consequences of glucose dysregulation on the vascular system and provide further evidence to track all parameters involved in glycemic metabolism to improve vascular health.