Impaired microcirculation in the skin and subclinical atherosclerosis in individuals with dysglycaemia in a large population-based cohort.

Abstract

Background and aim: Dysglycaemia is a known risk factor for cardiovascular disease and microcirculatory dysfunction is associated with an increased cardiovascular disease risk. The aim of this study was to investigate the prevalence of impaired microcirculation, coronary atherosclerosis, and arterial stiffness in individuals with normo- and dysglycaemia.

Methods: The study included 3,300 participants with microcirculatory measurements and information on glycaemic status, aged 50-65 years, from the Linköping site of the Swedish CArdio-Pulmonary bioImage Study (SCAPIS). Microvascular function was assessed in forearm skin using an arterial occlusion and release protocol determining peak blood oxygen saturation (OxyP). Data on pulse wave velocity (PWV) and the Coronary Artery Calcification Score (CACS) were collected. Participants were categorised into three glycaemic categories: normoglycaemia, prediabetes and diabetes.

Results: OxyP was lower in the prediabetes group - 1.2%-units, 95% CI (-1.8 to -0.6) and in study participants with diabetes - 2.4%-units, 95% CI (-3.1 to -1.6) compared to the normoglycaemic group 84.3%, 95% CI (83.6 to 84.9). PWV and CACS were higher in participants with dysglycaemia. Prevalent impaired function at three vascular levels (lowest quartile of OxyP + PWV ≥ 10 m/s and CACS ≥ 100) were observed in 0.8%, 2.3% and 7.6% in the glycaemic categories respectively. The difference between the normoglycaemic and the diabetes category and the difference between the pre-diabetes and the diabetes category was significant, p = < 0.05.

Conclusions: Patients with prediabetes and diabetes are more likely to have impaired microcirculation in the forearm skin and macrovascular disorders such as arterial stiffness and atherosclerosis in the coronary arteries compared to normoglycaemic individuals.