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- December 1, 2008 |
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| Presentation |
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"Large Artery Stiffness and Diabetes"Dr. Bronwyn Kingwell (biography)
English - 2005-06-18 - 44 minutes
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 | (48 slides) |
Summary :
In this presentation Dr. Kingwell talks about large artery stiffness, which is a topic of current interest as it is known to predict cardiovascular outcomes, and is of particular importance in diabetic patients.
Type 2 diabetes is characterised by a stiffening of the large arteries (1). The mechanisms of arterial stiffening are various and can be of a functional or structural type. Advanced glycation end-products play an important role in stiffening of the vessels in diabetic patients (2).
Arterial stiffness is associated with impaired peripheral blood flow in diabetic patients (3), and has been associated with poorer survival in hypertensives (4) and those with ESRD (5). In those with type 2 diabetes, the Hoorn study showed an association between pulse pressure and cardiovascular mortality (6).
How can arterial stiffness be reduced? This can be achieved by targeting the functional or structural mechanisms, for example with the use of antihypertensive agents or cross-link breakers. Dr. Kingwell presents some animal data, and reviews clinical studies on pharmacotherapy (thiazolidinediones, ACE inhibitors and statins) or exercise and their ability to modulate arterial stiffness/ compliance in different patient groups including those with type 2 diabetes.
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Physiological consequences of arterial stiffening
- Arterial stiffness in diabetes
- Mechanisms of arterial stiffening
- Implications of large artery stiffness in diabetic patients
- Impact of various therapies on large artery stiffness
Bibliographic references :
1. Miranda T. Schram; Ronald M.A Henry; Rob A.J.M van Dijk; Piet J. Kostense; Jacqueline M. Dekker; Giel Nijpels; Robert J. Heine; Lex M. Bouter; Nico Westerhof; Coen D.A. StehouwerIncreased Central Artery Stiffness in Impaired Glucose Metabolism and Type 2 Diabetes: The Hoorn StudyHypertension. 2004;43:176.
2. Mark E. CooperImportance of advanced glycation end products in diabetes-associated cardiovascular and renal disease American Journal of Hypertension.Volume 17, Issue 12, Supplement 1 , December 2004, Pages S31-S38.
3. Eiji Suzuki, MD, Atsunori Kashiwagi, MD, Yoshihiko Nishio, MD, Katsuya Egawa, MD, Shinya Shimizu, MD, Hiroshi Maegawa, MD, Masakazu Haneda, MD, Hitoshi Yasuda, MD, Shigehiro Morikawa, MD2, Toshiro Inubushi, PHD2 and Ryuichi Kikkawa, MDIncreased Arterial Wall Stiffness Limits Flow Volume in the Lower Extremities in Type 2 Diabetic Patients Diabetes Care 24:2107-2114, 2001.
4. Stéphane Laurent; Pierre Boutouyrie; Roland Asmar; Isabelle Gautier; Brigitte Laloux; Louis Guize; Pierre Ducimetiere; Athanase BenetosAortic Stiffness Is an Independent Predictor of All-Cause and Cardiovascular Mortality in Hypertensive Patients Hypertension. 2001;37:1236.
5. Jacques Blacher, MD; Alain P. Guerin, MD; Bruno Pannier, MD; Sylvain J. Marchais, MD; Michel E. Safar, MD; Gérard M. London, MDImpact of Aortic Stiffness on Survival in End-Stage Renal Disease Circulation. 1999;99:2434-2439.
6. Schram, Miranda T.; Kostense, Pieter J.; van Dijk, Robert A. J. M.; Dekker, Jacqueline M.; Nijpels, Giel; Bouter, Lex M.; Heine, Robert J.; Stehouwer, Coen D. A. Diabetes, pulse pressure and cardiovascular mortality: the Hoorn Study. Journal of Hypertension. 20(9):1743-1751, September 2002.
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