Risk Factors Associated with Arterial Stiffness in Diabetic Nephropathy in an Asian Population Cohort

Abstract

Introduction. Individuals with diabetic nephropathy (DN) are at risk for cardiovascular disease. Arterial stiffness summarizes an individual’s global cardiovascular risk burden. We investigated the relationship between major modifiable metabolic risk factors (excluding blood pressure) and arterial stiffness DN. Methods. Cross sectional study of 353 Diabetic Asians with Modified Diet to retard Renal Disease (MDRD) formula estimated glomerular filtration rate (eGFR) <90 mls/min/1.73m2. Central Aortic Systolic Pressure (CASP), a surrogate measurement of arterial stiffness, was estimated using validated BPro A-PulseTM tonometry. Visceral fat area (VFA) was estimated by tetrapolar multi-frequency bio-impedence. Results. Study population: 61% male, 9% current smoker, 84% receiving lipid lowering therapy and 45% taking insulin. Mean age(SD) was 61(9) year, CASP 130.0(21.4) mmHg, HBA1c 8.1(1.7)%, eGFR 50.1(26.8) mls/min/1.73m2, urinary albumin-creatinine ratio (ACR) 662(1339) mg/g, LDL 2.67(0.92) mM, VFA 130.0(31.9) cm2. After adjusting for age, gender, ethnicity and smoking status, eGFR (ß coefficient=-0.13) and HBA1c (1.66) remained as significant independent predictors of CASP (P<0.05). However, all the tested modifiable risk factors collectively explained only ~10% of variation in CASP. Conclusion. GFR and HBA1c are modifiable predictive factors for arterial stiffness in DN. However, our results suggested the presence of undiscovered novel risk factors.