Three noninvasive methods in the evaluation of subclinical cardiovascular disease in patients with diabetic retinopathy: endothelial dysfunction, serum E-selectin level and monocyte to HDL ratio

Year 2020, Volume: 3 Issue: 1, 36 - 41, 15.01.2020

Seyfullah Kan , Adnan Karaibrahimoğlu

https://doi.org/10.32322/jhsm.640760

Abstract

ABSTRACT

Aim:
Cardiovascular
risk has increased in diabetic retinopathy (DR). Brachial artery flow mediated
dilation (FMD) is a non-invasive method used to evaluate endothelial
dysfunction. Measurement of adhesion molecules such as E-selectin is the
indirect method of predicting endothelial dysfunction. Monocyte/ HDL ratio
(MHR) is a novel marker found to be related with cardiovascular diseases. In
this study, in DR patients without an apparent cardiovascular disease, we aimed
to investigate the relation between endothelial dysfunction indicators such as
MHR, FMD, E-selectin and subclinical atherosclerosis.

Material
and Method: In this study, 96 diabetic patients without apparent
cardiac symptoms and 32 healthy control patients that matched for gender, age
and body mass index (BMI) were included. The patients were separated into four
groups as; nonproliferative diabetic retinopathy (NPDR, n=31), proliferative
diabetic retinopathy (PDR, n=32), diabetic patients without a retinopathy
(n=33)  and control group (n=33).
Anthropometric, biochemical values and FMD were measured. Correlation and
regression analysis were done for the relation between MHR and FMD.

Results: MHR was significantly high in PDR group
(p<.001). E-selectin and FMD which
are indicators for endothelial dysfunction were significantly different between
groups (p< .001). E-selectin measures
were highest in PDR group, lower in NPDR group, however it was significantly
higher than DM and control groups (p=
.026). Inversely proportional to E-selectin, FMD was significantly higher
in control and significantly lower in PDR group (p< .001). Univariate logistic regression method was used to
determine factors that had an influence on FMD. Glucose, HbA1C, CRP and MHR had
a negative effect.

Conclusion: In patients with DR, MHR levels
might be used as a novel non-invasive marker to determine early atherosclerotic
risk.

Keywords

Diabetic retinopathy, MHR, FMD, , E-Selectin

References

• 1. Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation 2004; 109(23 Suppl 1): III27-32.
• 2. Korkmaz H, Onalan O. Evaluation of endothelial dysfunction: flow-mediated dilation. Endothelium 2008; 15(4): 157–63.
• 3. Libby P, Ridker PM, Hansson GK, Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 2009; 54(23): 2129–38.
• 4. Widlansky ME, Gokce N, Keaney JF, Vita JA. The clinical implications of endothelial dysfunction. J Am Coll Cardiol 2003; 42(7): 1149–60.
• 5. Mohamed Q, Gillies MC, Wong TY. Management of diabetic retinopathy: a systematic review. JAMA 2007; 298(8): 902–16.
• 6. Cheung N, Mitchell P, Wong TY. Diabetic retinopathy. Lancet (London, England) 2010; 376(9735): 124–36.
• 7. van Hecke M V, Dekker JM, Nijpels G, Moll AC, Heine RJ, Bouter LM, et al. Inflammation and endothelial dysfunction are associated with retinopathy: the Hoorn Study. Diabetologia 2005; 48(7): 1300–6.
• 8. Carbonell M, Castelblanco E, Valldeperas X, Betriu À, Traveset A, Granado-Casas M, et al. Diabetic retinopathy is associated with the presence and burden of subclinical carotid atherosclerosis in type 1 diabetes. Cardiovasc Diabetol 2018; 17(1): 66.
• 9. van Hecke M V, Dekker JM, Stehouwer CDA, Polak BCP, Fuller JH, Sjolie AK, et al. Diabetic retinopathy is associated with mortality and cardiovascular disease incidence: the EURODIAB prospective complications study. Diabetes Care 2005; 28(6): 1383–9.
• 10. Rajala U, Pajunpää H, Koskela P, Keinänen-Kiukaanniemi S. High cardiovascular disease mortality in subjects with visual impairment caused by diabetic retinopathy. Diabetes Care 2000; 23(7): 957–61.
• 11. Ganjali S, Gotto AM, Ruscica M, Atkin SL, Butler AE, Banach M, et al. Monocyte-to-HDL-cholesterol ratio as a prognostic marker in cardiovascular diseases. J Cell Physiol 2018; 233(12): 9237–46.
• 12. Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, et al. Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet (London, England) 1992; 340(8828): 1111–5.
• 13. Duby JJ, Campbell RK, Setter SM, White JR, Rasmussen KA. Diabetic neuropathy: an intensive review. Am J Health Syst Pharm 2004; 61(2): 160–73; quiz 175–6.
• 14. Tesfamariam B. Free radicals in diabetic endothelial cell dysfunction. Free Radic Biol Med 1994; 16(3): 383–91.
• 15. Son J-W, Jang E-H, Kim M-K, Kim IT, Roh YJ, Baek K-H, et al. Diabetic retinopathy is associated with subclinical atherosclerosis in newly diagnosed type 2 diabetes mellitus. Diabetes Res Clin Pract 2011; 91(2): 253–9.
• 16. Targher G, Bertolini L, Tessari R, Zenari L, Arcaro G. Retinopathy Predicts Future Cardiovascular Events Among Type 2 Diabetic Patients: The Valpolicella Heart Diabetes Study. Diabetes Care 2006; 29(5): 1178–1178.
• 17. Klein R, Klein BE, Moss SE, Cruickshanks KJ. Association of ocular disease and mortality in a diabetic population. Arch Ophthalmol (Chicago, Ill 1960) 1999; 117(11): 1487–95.
• 18. Turhan H, Saydam GS, Erbay AR, Ayaz S, Yasar AS, Aksoy Y, et al. Increased plasma soluble adhesion molecules; ICAM-1, VCAM-1, and E-selectin levels in patients with slow coronary flow. Int J Cardiol 2006; 108(2): 224–30.
• 19. Libby P. Inflammation in atherosclerosis. Nature 2002; 420(6917): 868–74.
• 20. Sercelik A, Besnili AF. Increased monocyte to high-density lipoprotein cholesterol ratio is associated with TIMI risk score in patients with ST-segment elevation myocardial infarction. Rev Port Cardiol 2018; 37(3): 217–23.
• 21. Inonu Koseoglu H, Pazarli AC, Kanbay A, Demir O. Monocyte Count/HDL Cholesterol Ratio and Cardiovascular Disease in Patients With Obstructive Sleep Apnea Syndrome: A Multicenter Study. Clin Appl Thromb Hemost 2018; 24(1): 139–44.
• 22. Allahverdian S, Pannu PS, Francis GA. Contribution of monocyte-derived macrophages and smooth muscle cells to arterial foam cell formation. Cardiovasc Res 2012; 95(2): 165–72.
• 23. Chen JW, Li C, Liu ZH, Shen Y, Ding FH, Shu XY, et al. The Role of Monocyte to High-Density Lipoprotein Cholesterol Ratio in Prediction of Carotid Intima-Media Thickness in Patients With Type 2 Diabetes. Front Endocrinol (Lausanne) 2019; 10.
• 24. Kanbay M, Solak Y, Unal HU, Kurt YG, Gok M, Cetinkaya H, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol 2014; 46(8): 1619–25.