Endothelial dysfunction in type 2 diabetic patients with normal coronary arteries: A digital reactive hyperemia study

Paola Gargiulo, Caterina Marciano, Gianluigi Savarese, Carmen D'Amore, Stefania Paolillo, Giovanni Esposito, Maurizio Santomauro, Fabio Marsico, Donatella Ruggiero, Oriana Scala, Antonio Marzano, Milena Cecere, Laura Casaretti, Pasquale Perrone Filardi

Research output: Contribution to journalArticlepeer-review


Background: To assess endothelial function (EF) in type 2 diabetic patients with angiographically normal coronaries compared to diabetic patients with obstructive coronary artery disease (CAD) and to non-diabetic patients, with and without CAD. Methods: One hundred eighty-three patients undergoing coronary angiography were divided in: group 1 with diabetes mellitus (DM) and CAD (n = 58); group 2 with DM without CAD (n = 58); group 3 with CAD without DM (n = 31) and group 4 without CAD and DM (n = 36). EF was assessed by reactive hyperemia index (RHI) using a fingertip peripheral arterial tonometry and compared to values obtained in 20 healthy volunteers. Results: RHI was significantly lower in patients with DM compared to patients without DM (1.69 ± 0.38 vs 1.84 ± 0.44; p = 0.019). RHI was comparable among groups 1, 2 and 3, each value being significantly lower compared to group 4 (2 ± 0.44; p <0.001 vs group 1; p <0.005 vs group 2; p <0.002 vs group 3). At multivariate analysis DM and CAD were significant predictors of endothelial dysfunction (ED) (OR = 2.29; p = 0.012; OR = 2.76; p = 0.001, respectively), whereas diabetic patients (n = 116) CAD and glycated haemoglobin (HbA1c) were independent significant predictors of ED (OR = 3.05; p = 0.009; OR = 1.96; p = 0.004, respectively). Diabetic patients with ED (n = 67) had higher levels of HbA1c than diabetic patients with normal endothelial function (7.35 ± 0.97 vs 6.87 ± 0.90; p = 0.008) and RHI inversely correlated to HbA1c (p = 0.02; r = - 0.210). Conclusions: Diabetic patients with and without CAD show significantly impaired peripheral vascular function compared to non-diabetic patients without CAD. ED in diabetic patients without CAD is comparable to that of patients with CAD but without DM. HbA1c is a weak independent predictor of ED.

Original languageEnglish
Pages (from-to)67-71
Number of pages5
JournalInternational Journal of Cardiology
Issue number1
Publication statusPublished - Apr 30 2013


  • Coronary artery disease
  • Endothelial dysfunction
  • Type 2 diabetes mellitus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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