Volha Vasilkova

ASSESSMENT OF CARDIOVASCULAR RISK IN DIABETIC PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: Diabetic patients with chronic kidney disease (CKD) have an increased risk of cardiovascular disease. We aimed to investigate echocardiogram parameters in relation to estimated glomerular filtration rate (eGFR) and urine albumin/creatinine ratio (ACR). Design and method: We investigated 176 patients both sexes with diabetes type 1 and type 2 aged 55.54 ± 8.37 years. Control group included 50 healthy subjects the same age. Echocardiography was performed to measure left ventricular mass index (LVMI), LV hypertrophy (LVH), systolic function, and diastolic function. LVH was defined as LVMI of 125 g/m2 or more for males and as LVMI of 110 g/m2 or more for females. The renal function of the diabetic patients was evaluated using the albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR), which was calculated by CKD-EPIscr_cys equation. Results: The prevalence of LVH was higher in diabetic patients with lower values of eGFRscr_cys than in those with normal renal function (56.4% vs 7.1%, respectively, p < 0.05). Diastolic dysfunction of LV was prevalent in 61,4% with the declining renal function vs 7,4% of diabetic patients with normal renal function, p < 0.001. The eGFRscr_cys was negatively associated with total cholesterol, apo-B, uric acid, hs-CRP, pro-BNP and BNP (p < 0.05) and positively associated with left ventricular ejection fraction (LVEF) (p < 0.001). We observed significantly higher LVMI mass index according to reduced eGFRscr_cys (trend p < 0.001) and increased ACR (trend p < 0.001). The multiple regression analysis confirmed the inverse association between eGFRscr_cys and LVMI independently of confounding factors. Conclusions: We confirmed the high prevalence of LVH in patients with diabetes and CKD. Echocardiographic LVH and LV diastolic dysfunction may be predictors of low eGFR in diabetic patients with CKD. Taking into account the pathophysiological processes behind cardiorenal syndrome, cardiac assessment should be evaluated in patients with diabetes and CKD.

CYSTATIN C IS ASSOCIATED WITH THE PRESENCE OF CAROTID ATHEROSCLEROSIS IN PATIENTS WITH DIABETES TYPE 2 AND CHRONIC KIDNEY DISEASE

Objective: Cystatin C has been proposed as a novel marker of renal function and as a predictor of the severity of coronary atherosclerosis and future cardiovascular events. The aim was to evaluate the possible role of chronic kidney disease and particularly CysC on the characteristics of carotid atherosclerosis in patients with type 2 diabetes (DT2). Design and method: We investigated 195 patients both sexes with DT2 aged 56.54 ± 4.17 years. Control group included 84 healthy subjects the same age. The intima-media thickness (IMT) was measured as the distance between the lumen-intima interface and the media-adventitia interface. Atherosclerotic plaque was defined as a focal structure encroaching into the arterial lumen of 0.5 mm or 50% of the surrounding IMT value. Total plaque area (TPA) was calculated as the sum of all plaque areas. GFR was estimated using the modification of diet in renal disease (MDRD) equation. Results: Patients were divided into 2 groups by CysC levels tertiles. Patients in the high CysC tertile (n = 76) had significantly higher mean carotid IMT (0.88 ± 0.12 mm vs. 0.76 ± 0.07 mm, P = 0.03), and TPA (4.69 ± 2.03 mm2 vs. 2.71 ± 0.57 mm2, P = 0.02) compared to patients in the lower tertiles (n = 119). CysC levels demonstrated significant positive correlation with the mean carotid IMT (r = 0.35, P = 0.011). In multivariate analyses adjusted for cardiovascular risk factors, the association between CysC and IMT remained significant (P = 0.037). In contrast, neither serum creatinine nor estimated GFR were associated with IMT (P = 0.17). Conclusions: Our study demonstrated a significant association of increased CysC levels with characteristics of carotid atherosclerosis in patients with type 2 diabetes and chronic kidney disease.

PS 02-22 ASSOCIATION OF DYSLIPIDEMIA, HYPERTENSION AND CHRONIC KIDNEY DISEASES WITH CAROTID ATHEROSCLEROSIS IN PATIENTS WITH TYPE 2 DIABETES

Objective: to assess the possible role of dyslipidemia, hypertension and chronic kidney diseases (CKD) on the characteristics of carotid atherosclerosis in elderly patients with type 2 diabetes (DT2). Design and Method: We investigated 86 patients both sexes with DT2 aged 65.54 ± 10.37 years (from 55 to 75 years). Control group included 34 healthy subjects the same age. The intima-media thickness (IMT) was measured as the distance between the lumen-intima interface and the media-adventitia interface. Atherosclerotic plaque was defined as a focal structure encroaching into the arterial lumen of 0.5 mm or 50% of the surrounding IMT value. Total plaque area (TPA) was calculated as the sum of all plaque areas. Results: The mean blood glucose and HbA1c level were 8.52 ± 3.10 mmol/L and 6.59 ± 1.88%, respectively. We divided all patients into 3 groups: Group 1 (n = 24) patients did not have any additional atherosclerosis risk factor, Group 2 (n = 25) patients had one additional atherosclerosis risk factor, and Group 3 (n = 37) patients had two or three additional atherosclerosis risk factors. Using multiple linear regression analysis adjusted for confounding factors, IMT and TPA were significantly correlated with age > 60 years (&bgr; = 0.359, p < 0.0001; &bgr; = 0.263, p < 0.0001), hypertension (&bgr; = 0.041, p = 0.003; &bgr; = 0.126, p < 0.0001), dyslipidemia (&bgr; = 0.066, p = 0.0001; &bgr; = 0.125, p < 0.0001) and CKD (&bgr;=0.054, p = 0.003; &bgr; = 0.165, p < 0.0001), respectively. However, gender (men) was not significantly correlated with IMT (p = 0.171) and TPA (p = 0.112). We found a significant difference in carotid IMT between left and right carotid artery (0.70 ± 0.16 mm versus 0.66 ± 0.13 mm, p < 0,001, respectively). There were no significant difference in carotid IMT between patients with plague and without plague (p = 0.171). Conclusions: We showed the role of additional atherosclerosis risk factors to carotid atherosclerosis in elderly patients with DT2. In these patients, the presence of dyslipidemia, hypertension, and different CKD status were predictors of carotid plaque.

PS 14-13 N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE LEVEL IN TYPE 2 DIABETIC PATIENTS

Objective: A diabetic state is causally related to heart failure (HF) which is a leading cause of mortality. Early detection of high-risk individuals is imperative for primary prevention. The aim of this study was to investigate the role of N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) in patients with diabetes type 2 (DT2). Design and Method: We investigated 86 patients both sexes with DT2 aged 65.54 ± 11.37 years (from 50 to 65 years) without clinical cardiovascular disease at baseline. Plasma levels of NT-proBNP and other biochemical data were measured. Control group included 34 healthy subjects the same age. Results: NT-proBNP level increased with age in both the diabetic group and control group but patients with DT2 had higher NT-proBNP levels (p < 0.05). NT-proBNP was significantly correlated with HbA1c (r = 0.53, p < 0.001), serum creatinine (r = 0.62, p < 0.001), serum cystatin C (r = 0.48, p < 0.001), and age (r = 0.31, p < 0.001). Multivariate linear regression analysis of the significant variables showed that age (p = 0.011), male gender (p = 0.012), triglyceride (p < 0.001), systolic blood pressure (p < 0.001), and cystatin C (p < 0.001) were the independent predictors of fasting serum log-NT-proBNP levels in diabetic patients. Conclusions: We showed the role of risk factors to heart failure in patients with DT2. In these patients, the presence of dyslipidemia, hypertension, and renal impairments were predictors of fasting serum log-NT-proBNP levels. Thus adjustments for the age, sex and renal function are necessary for determining cardiac risk based on NT-proBNP level.

OP0309 Association of Bone Mineral Density and Carotid Atherosclerosis in Patients with Diabetes Type 2

Background Many epidemiological studies have shown that low bone mineral density (BMD) and atherosclerosis appear to be related. However, their precise correlation is not completely understood [1,2]. Objectives The aim of this study was to examine the relationship between bone mass and carotid measurements in patients with diabetes type 2 (DT2). Methods 105 patients both sexes with type 2 diabetes aged 54.69±11.07 years were studied. Control group included 84 healthy subjects the same age. Osteoporosis was defined as a femoral neck BMD T score below -2.5. Carotid intima media thickness (cIMT) and carotid plaque occurrence were determined by B-mode ultrasound and BMD by dual-energy X-ray absorptiometry. The plaques were measured in both common and internal carotid arteries. Results BMD and cIMT were inversely associated both in patients and controls. The correlation was stronger in females than in males, and in females, the correlation was stronger after menopause. Patients with DT2, with carotid plaque had higher cIMT at low BMD than at normal BMD, p=0.020. Multiple linear regression analysis reveals that age (p<0.001), smoking (p=0.016), and osteoporosis (p=0.001) were significantly associated with increased cIMT. In women, cIMT was significantly related to age (p=0.01) and osteoporosis (p=0.03). In men, though there was no significant relationship, a trend toward old age and having osteoporosis was observed in increased cIMT (p=0.054, p=0.075). Conclusions The association between carotid atherosclerosis and bone metabolism has become an increasing focus of interest in recent years [3], and accumulating evidence has shown that atherosclerosis and osteoporosis frequently co-exist. We found inverse association between BMD and carotid measurements in both diabetic patients and controls. Diabetes type 2 patients, especially postmenopausal women, with decreased BMD may have a higher risk of developing coronary atherosclerosis. References Marcovitz PA, Tran HH, Franklin BA et al. Usefulness of bone mineral density to predictsignificant coronary artery disease. AmerJ Cardiol 2005; 96(8): 1059–1063. Mussolino ME, Armenian HK. Low bone mineral density, coronary heart disease, and stroke mortality in men and women: the Third National Health and Nutrition Examination Survey. Annals Epidemiol 2007; 17(11): 841–846. Mitchell G.F., Vita J.A., Larson M.G., Parise H., Keyes M.J., Warner E., Vasan R.S., Levy D., Benjamin E.J. Cross-sectional relations of peripheral microvascular function, cardiovascular disease risk factors, and aortic stiffness: the Framingham Heart Study. Circulation. 2005; 112(24): 3722–3728. Acknowledgement Thanks to colleagues at our center for technical help and data acquisition. Disclosure of Interest None declared