Circulating plasma vascular endothelial growth factor and microvascular complications of Type 1 diabetes mellitus: the influence of ACE inhibition

Aims To determine whether circulating plasma vascular endothelial growth fa ctor (VEGF) is elevated in the presence of diabetic microvascular complicat ions, and whether the impact of angiotensin-converting enzyme (ACE) inhibit ors on these complications can be accounted for by changes in circulating V EGF. Methods Samples (299/354 of those with retinal photographs) from the EUCLID placebo-controlled clinical trial of the ACE inhibitor lisinopril in mainl y normoalbuminuric non-hypertensive Type 1 diabetic patients were used. Alb umin excretion rate (AER) was measured 6 monthly. Geometric mean VEGF level s by baseline retinopathy status, change in retinopathy over 2 years, and b y treatment with lisinopril were calculated, Results No significant correlation was observed between VEGF at baseline an d age, diabetes duration, glycaemic control, blood pressure, smoking, fibri nogen and von Willebrand factor. Mean VEGF concentration at baseline was 11 .5 (95% confidence interval 6.0-27.9) pg/ml in those without retinopathy, 1 2.9 (6.0-38.9) pg/ml in those with non-proliferative retinopathy, and 16.1 (8.1-33.5) pg/ml in those with proliferative retinopathy (P = 0.06 for tren d). Baseline VEGF was 15.2 pg/ml in those who progressed by at least one le vel of retinopathy by 2 years compared to 11.8 pg/ml in those who did not ( P = 0.3). VEGF levels were not altered by lisinopril treatment. Results wer e similar for AER. Conclusions Circulating plasma VEGF concentration is not strongly correlate d with risk factor status or microvascular disease in Type 1 diabetes, nor is it affected by ACE inhibition. Changes in circulating VEGF cannot accoun t for the beneficial effect of ACE inhibition on retinopathy.