Malygina, O.F.

Volkova, Ekaterina A.

Vorochobina, N.V.

Zelenina, T.A.

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Giorn. It. Ost. Gin. Vol. XXVII - n. 5 Maggio 2005Endothelial dysfunction in postmenopausal women with type 2 diabetesN.V. VOROCHOBINA, O.F. MALYGINA, T.A. ZELENINA, E.A. VOLKOVA183The epidemic of diabetes mellitus is constantlygrowing. Severe and expensive diabetic complicationsare disturbances in the macro-microcirculation.Moreover these functional disturbances starts earlyafter the onset of diabetes and determines the progres-sion of other diabetic complications. Endothelialdysfunction is an indicator of the blood circulatorydisturbances and depends from the several factors. As,the low blood estrogen level in postmenopausalwomen with diabetes can deteriorate endothelialdysfunction. However, role of clinical and biochemicalfactors in development of endothelial dysfunction inpostmenopausal women with diabetes remains unclear.The presents of endothelial dysfunction as considerconstitutes an independent predictor of cardiovascularevents. Besides, endothelial dysfunction can playimportant role in the progression of diabetic chronicfoot ulceration that leads to amputation in 10-15% ofthe diabetic patients. These functional disturbancesneed in early detection for prevention the developmentof cardiovascular disease and chronic diabetic compli-cations. Thus noninvasive and easily techniques arerequired for the discover endothelial dysfunction.Because endothelial dysfunction presents in all vessels,the assessment of peripheral vascular endothelial func-tion are considered as adequate screening methods.Doppler ultrasound highfrequency study is a noninva-sive and adequate technique of measuring microvascu-lar circulation, endothelialdependent and endothelialin-dependent vessel responsiveness. The assessment ofdigital blood flow changes during reactive hyperemiaby this technique allows to discover endothelialdysfunction.MethodsIn a study, we examined the endothelial-depen-dent vessel responses in postmenopausal women withdiabetes mellitus. There were 27 women with meanage of 53 years (range 50 to 55) entered into thisstudy. We excluded patients with clinical evidence ofcardiovascular disease, peripheral vascular disease,uncontrolled arterial hypertension, severe renal, hepa-tic, respiratory, ophthalmologic or hematological con-ditions, or diabetic ulceration. Total cholesterol, tri-glycerides, HDL-cholesterol and none-HDL-chole-sterol in blood were estimated. Besides estradiol, totaltestosterone, follicle-stimulating hormone, luteinizinghormone were also measured by specific immu-noenzymoassay.For wrist and foot digital skin microvascular ves-sels basal blood flow and endothelialdependentresponsiveness were assessed by Doppler ultrasoundhighfrequency technique. Measuring reactive hypere-mia perfusion changes assessed vascular responsive-ness.Blood pressure cuffs were placed on forearm andleg. The baseline vessels flow was measured on onewrist and foot digital. After a 10-min equilibrationperiod the forearm blood pressure cuff was inflatedto 200 mm Hg for 5 min. Then the cuff was deflatedand changes of microvascular blood flow were asses-sed on 1, 3 and 5 min. After that same probe wasperformed in leg. Peripheral blood flow was excludedvia leg cuff (250 mm Hg). The magnitude of reactivehyperemia flow was also measured on 1, 3 and 5 min.The measure of reactive hyperemia was calculated asthe ratio of the magnitude vessel blood flow aftercuff defloration to baseline blood flow.Results are expressed as mean ± SEM. Data werecompared by Student’s test. The null hypothesis wasrejected at P<0.05.ResultsEstradiol level in blood was significantly lower andfollicle-stimulating hormone, luteinizing hormonelevels were higher then in female of childrearingpotential. There was no difference in testosteroneMedical Academy of Postgraduate EducationDept. of EndocrinologySt. Elisabeth Hospital,St. Petersburg, Russian Federation© Copyright 2005, CIC  Edizioni Internazionali, Romalevel in both groups. Baseline characteristics are shown in a table. In70.5% cases the skin basal blood flow of wrist wasnormal. But all subjects showed a very low level offoot perfusion. There were no differences betweenthe patients with basal normal flow and basal lowflow with respect to age, body mass index, systolicand diastolic blood pressure, plasma concentrationsof cholesterol, triglycerides, HDL-cholesterol andnone-HDL-cholesterol, or HbA1c level (Table 1).The impaired vascular endothelialdependentresponse in wrist and foot digitals was observed inall subjects. Abnormal decreasing of reactive hypere-mia blood flow in finger was obtained in 33%women. Low vasodilator a response was observes inother subjects (increasing of reactive hyperemiablood flow less than 50%). Moreover magnitude ofreactive hyperemia reaction independed on baselineblood flow characteristics. It was estimated that obe-sity, high triglyceride or low HDL-cholesterol levelsassociate with the abnormal vasoconstrictorendotheliumdependent reaction of wrist vessels(Table 2). Moreover there were no reactive hypere-mia foot vessels responses in all subjects.ConclusionsIt is known that microcirculation disturbances,especially endothelial dysfunction, can lead to diabe-tic ulceration development. Besides endothelialdysfunction is independent predictor of cardiovascu-lar events. This study shows that endothelialdysfunction presents in all postmenopausal womenwith diabetes and without diabetic ulceration and cli-nical of coronary disease. Abnormal decreasing ofreactive hyperemia blood flow in wrist is discoveredin women with obesity and high triglyceride level orlow HDL-cholesterol level. In this group of patientsthe foot microcirculatory disturbances is more severethan in wrist. Additional studies are required to esta-blish the influence of difference clinical and bioche-mical factors on endothelial dysfunction develop-ment in postmenopausal women with diabetes.N.V. Vorochobina e Coll.184TABLE 1 - BASELINE CHARACTERISTICS OF SUBJECTSWITH NORMAL (N=19) AND LOW (N=8) WRIST PERFU-SION.Baseline characteristics n=19 n=8Age, y 52.4±1.8 53.1±2.0BMI, kg/m2 28.4±2.6 29.0±1.2HbA1c, % 7.2±0.3 7.1±0.2Systolic BP, mm Hg 135±5 138±3Diastolic BP, mm Hg 87±5 85±6Total cholesterol, mmol/l 6.5±0.32 6.4±0.48Tryglycerides mmol/l 2.0±0.42 2.1±0.46HDL-cholesterol, mmol/l 1.5±0.1 1.4±0.2None-HDL-cholesterol, mmol/l 5.4±0.31 5.36±0.2Baseline wrist blood flow (sm/sec) 6.8±0.8 2.4±0.6TABLE 2 - CHARACTERISTICS OF SUBJECTS WITH LOWINCREASING (N=19) AND ABNORMAL DECREASING(N=8) OF REACTIVE HYPEREMIA FLOW IN WRIST.Characteristics n=9 n=18Age, y 51.4±1.6 52.8±1.8BMI, kg/m2 26.8±1.5 28.5±1.8*HbA1c, % 6.9±0.8 7.2±0.4Total cholesterol, mmol/l 5.8±0.8 6.4±0.2Triglycerides, mmol/l 1.1±0.2 2.2±0.5*HDL-cholesterol, mmol/l 1.9±0.2 1.5±0.2*None-HDL-cholesterol, mmol/l 5.2±0.4 5.4±0.3Baseline wrist blood 5.8±0.7 6.2±0.5flow (sm/sec)Reactive hyperemia vessel +38±12.6 -26±10.4*reaction in wrist (%)Baseline foot blood flow 1.8±0.7 2.4±0.6(sm/sec)Reactive hyperemia vessel 0 0reaction in foot (%)*p < 0.05 vs. subjects with low increasing of reactive hyperemiaflow in wrist.

Endothelial dysfunction in postmenopausal women with type 2 diabetes

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Endothelial dysfunction in postmenopausal women with type 2 diabetes

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