Endothelial cell dysfunction and arterial wall hypertrophy are associated with disturbed carbohydrate metabolism in patients at risk for cardiovascular disease

To investigate the effects of fasting and postprandial glucose on endotheli al cell function and intima-media thickness, we studied 60 men with cardiov ascular risk factors. Postischemic, endothelium-dependent vasodilatation wa s measured after 3 minutes of ischemia at the radial artery with high-resol ution echo tracking. Common carotid artery intima-media thickness was measu red by B-mode ultrasound. Glucose tolerance was determined by a 75-g oral g lucose load. Fasting glucose levels were inversely correlated with postisch emic, endothelium-dependent vasodilatation (r= -0.24, P<0.05) and directly correlated with intima-media thickness (r=0.26, P<0.05). However, postische mic, endothelium-dependent vasodilatation and intima-media thickness were n ot correlated. All subjects with normal postischemic, endothelium-dependent vasodilatation also had a normal intima-media thickness, whereas some subj ects with impaired postischemic, endothelium-dependent vasodilatation also had a normal intima-media thickness. Multiple regression analysis revealed a profound influence of age on intima-media thickness to the exclusion of a ll other variables. The same age-adjusted analysis for postischemic, endoth elium-dependent vasodilatation accepted fasting glucose, followed by 2-hour postprandial glucose, as variables, but no others. Subjects with fasting g lucose values >100 mg/dL showed reduced postischemic, endothelium-dependent vasodilatation (59 versus 120 mu m, P<0.05) and a higher intima-media thic kness (right: 0.76 versus 0.62 mm, P<0.05; left: 0.78 versus 0.63 mm, P<0.0 5) compared with those with fasting glucose values <100 mg/dL. Subjects wit h 2-hour postprandial glucose values >125 mg/dL had no reduced postischemic , endothelium-dependent vasodilatation compared with subjects with a 2-hour postprandial glucose >125 mg/dL; however, their intima-media thickness (ri ght: 0.66 versus 0.62 mm; left: 0.68 versus 0.62 mm; P<0.05 for both) was,g reater. Thus, high fasting rather than postprandial glucose values are asso ciated with both postischemic, endothelium-dependent vasodilatation and inc reased intima-media thickness. Postischemic endothelium- dependent vasodila tation may precede increased intima-media thickness.