Cardio-ankle vascular index and its association with type 2 diabetes mellitus and pre-diabetes: the results of the ESSE-RF study in Kemerovskaya region

Objective. To evaluate the relationship of pre-diabetes and diabetes mellitus (DM) with arterial stiffness assessed by cardio-ankle vascular index (CAVI).

Design and methods. Cross-sectional study in the framework of a multicenter epidemiological study “Epidemiology of cardiovascular diseases and their risk factors in the Russian Federation” (ESSE-RF) from March to October 2013. The object of the study was a random population sample of the Kemerovo region of males and females aged 25–64 years. Each participant provided written informed consent to the survey. Standard research protocol ESSE-RF extended by further study of peripheral arterial stiffness using VaSeraVS‑1000 (Fukuda Denshi, Japan) with automatic measurement of CAVI. The CAVI ≥ 9,0 was considered as pathological. Two patients with type 1 DM were excluded from a total sample of 1619 people. The remaining 1617 people were divided into three groups: Group 1 — patients with type 2 DM (n = 272), Group 2 — patients with prediabetes — impaired fasting glucose, impaired glucose tolerance or their combination (n = 44), Group 3 — persons without any confirmed carbohydrate metabolism disorder (n = 1301). Medical history and laboratory data and indicators of volume sphygmography (VaSera VS‑1000) were analyzed in groups depending on the presence of carbohydrate metabolism disorders.

Results. The type 2 DM was diagnosed in 16,6% patients, pre-diabetes — in 2,7%. Patients with DM and prediabetes were comparable for most indicators, but significantly different from patients without carbohydrate metabolism disorders. The prevalence of coronary heart disease, hypertension, obesity, stroke, kidney disease, dyslipidemia was higher among DM and pre-diabetic patients. The CAVI in patients with pre-diabetes and DM were higher (7,7 and 7,6) than in those without the carbohydrate metabolism disorders (7,2; p = 0,009 and p < 0,001, respectively). The incidence of pathologic CAVI (> 9,0) was higher among patients with DM and prediabetes (15,9% and 16,8%) compared with those with normoglycaemia (9,0%, p < 0,001 for trend). The CAVI positively correlated with age (r = 0,526, p < 0,001), male gender (r = 0,111, p < 0,001), type 2 DM (r = 0,128, p < 0,001), prediabetes (r = 0,071, p = 0,002), total cholesterol (r = 0,190, p < 0,001), triglycerides (r = 0,108, p < 0,001), low-density lipoprotein cholesterol (r = 0,186, p < 0,001), uric acid (r = 0,085, p < 0,001). The CAVI negatively correlated with the glomerular filtration rate GFR CKD-EPI (r = –0,461, p < 0,001). The regression analysis showed that CAVI values were associated with the presence of DM (odds ratio (OR) 1,185 with an increase in the CAVI for each unit, 95% confidence interval (CI) 1,100–1,276; p < 0,001), and pre-diabetes (OR 1,179, 95% CI 1,008–1,380; p = 0,044).

Conclusions. Prediabetic and DM patients have similar prevalence of cardiovascular risk factors, including increased stiffness of arteries. In a community sample of Western Siberia increase in CAVI was associated with both type 2 DM and prediabetes.

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