The Difference Value of Global Pulse Wave Velocity between Type 2 Diabetic and Non-diabetic Patients with Chronic Coronary Syndrome
Keywords:
Global pulse wave velocity, Chronic Coronary Syndrome, Type 2 Diabetes
Abstract
Background: Coronary Heart Disease (CHD) remains a major health issue in Indonesia. CHD could lead to myocardial infarction and sudden death, highlighting the necessity for cardiovascular examination and appropriate management to prevent increased morbidity and mortality rates. One non-invasive method for assessing CHD was measuring arterial stiffness using Global Pulse Wave Velocity (PWVg). This study aimed to assess the difference in PWVg among patients with Chronic Coronary Syndrome (CCS) with or without Type 2 Diabetes (T2DM).
Methods: This was an analytical cross-sectional study to evaluate the difference in PWVg values among CCS patients with or without T2DM. The study used data from medical records and elective coronary angiography at the Dr. M. Djamil Teaching Hospital’s cardiac catheterization laboratory, where PWVg was measured by Doppler echocardiography examination of CCS patients from April 2023 to 2024. Normality testing using the Shapiro-Wilk test was performed before analyzing all numerical data, followed by independent t-tests or Mann-Whitney tests to determine intergroup differences.
Results: The study comprised 36 CCS patients, with 18 samples per group (with and without T2DM). In this study, males were more prevalent in the CCS group without T2DM, smoking risk factors were more commonly found in the CCS group without T2DM, higher Random Blood Glucose (RBG) was found in the CCS group with T2DM, and higher Ankle-Brachial Index (ABI) values were observed in the CCS group without T2DM. Based on statistical analysis, there was a significant difference in PWVg values between the CCS group with T2DM and the group without T2DM (8.3 + 0.7 m/s vs. 7.7 + 0.5 m/s, p=0.009).
Conclusion: T2DM results in higher PWVg values compared to those without T2DM among patients with CCS.
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References
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26. Salehi N, Janjani P, Tadbiri H, Rozbahani M, Jalilian M. Effect of cigarette smoking on coronary arteries and pattern and severity of coronary artery disease: a review. J Int Med Res. 2021. Dec; 49:12.
27. Hirofumi Ohnishi, Shigeyuki Saitoh, Satoru Takagi, Jun-ichi Ohata, Takeshi Isobe, Yuka Kikuchi, Hiroshi Takeuchi, Kazuaki Shimamoto; Pulse Wave Velocity as an Indicator of Atherosclerosis in Impaired Fasting Glucose: The Tanno and Sobetsu Study. Diabetes Care 1 February 2003; 26 (2): 437–440.
28. Sadeghi M, Heidari R, Mostanfar B, Tavassoli A, Roghani F, Yazdekhasti S. The Relation Between Ankle-Brachial Index (ABI) and Coronary Artery Disease Severity and Risk Factors: An Angiographic Study. ARYA Atheroscler. 2011 Summer;7(2):68-73.
29. Wohlfahrt P, Palouš D, Ingrischová M, et al. A high ankle-brachial index is associated with increased aortic pulse wave velocity: the Czech post-MONICA study. European Journal of Cardiovascular Prevention & Rehabilitation. 2011;18(6):790-796.
30. Choi KM, Lee KW, Seo JA, Oh JH, Kim SG, Kim NH, et al. Relationship between brachial-ankle pulse wave velocity and cardiovascular risk factors of the metabolic syndrome. Diabetes Res Clin Pract 2004;66:57-61.
31. Yamashina A, Tomiyama H, Arai T, Hirose K, Koji Y, Hirayama Y, et al. Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk. Hypertens Res 2003;26:615-22.
2. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014; 35: 2950–59.
3. Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A, et al. 2013 ESC guidelines on the management of stable CAD: the Task Force on the management of stable CAD of the European Society of Cardiology. Eur Heart J. 2013; 34: 2949–3003.
4. Sajadieh A, Nielsen OW, Rasmussen V, Hein HO, Hansen JF. Prevalence and prognostic significance of daily-life silent myocardial ischaemia in middle-aged and elderly subjects with no apparent heart disease. Eur Heart J. 2005; 26: 1402-09.
5. Patel MR, Peterson ED, Dai D, Brennan JM, Redberg RF, Anderson HV, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010; 362: 886–95.
6. Blacher J, Asmar R, Djane S, London GM, Safar ME. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension. 1999; 33: 1111–17.
7. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010; 55: 1318–27.
8. Ben-Shlomo Y, Spears M, Boustred C, May M, Anderson SG, Benjamin EJ, et al. Aortic pulse wave velocity improves cardiovascular event prediction: an individual participant meta-analysis of prospective observational data from 17,635 subjects. J Am Coll Cardiol. 2014; 63: 636–46.
9. Funck KL, Laugesen E, Ovrehus K, Jensen JM, Norgaard BL, Dey D, et al. Increased high-risk coronary plaque burden is associated with arterial stiffness in patients with type 2 diabetes without clinical signs of coronary artery disease: a computed tomography angiography study. J Hypertens. 2017; 35:1235–43.
10. Kim BH, Jang JS, Kwon YS, Kim JH, Kim IJ, Lee CW. High brachial ankle pulse wave velocity as a marker for predicting coronary artery stenosis in patients with type 2 diabetes. Endocrinol Metab. 2018; 33:88–96.
11. Cwynar, Marcin et al. “Pulse wave velocity in patients with coronary artery disease or type 2 diabetes mellitus.” Acta Cardiologica 61 (2006): 421 - 426.
12. Braber TL, Prakken NH, Mosterd A, Mali WP, Doevendans PA, Bots ML, et al. Identifying coronary artery disease in asymptomatic middle-aged sportsmen: the additional value of pulse wave velocity. PLoS ONE. 2015; 10: e0131895.
13. Lee JY, Ryu S, Lee SH, Kim BJ, Kim BS, Kang JH, et al. Association between brachial-ankle pulse wave velocity and progression of coronary artery calcium: a prospective cohort study. Cardiovasc Diabetol. 2015; 14:147.
14. Torii S, Arima H, Ohkubo T, Fujiyoshi A, Kadota A, Takashima N, et al. Association between pulse wave velocity and coronary artery calcification in Japanese men. J Atheroscl Thromb.2015; 22:1266–77.
15. Vishnu A, Choo J, Wilcox B, Hisamatsu T, Barinas-Mitchell EJ, Fujiyoshi A, et al. Brachial-ankle pulse wave velocity is associated with coronary calcification among 1131 healthy middle-aged men. Int J Cardiol. 2015; 189:67–72.
16. Liao J, Farmer J. Arterial stiffness as a risk factor for coronary artery disease. Curr Atheroscler Rep. 2014;16(2):387.
17. Ikonomidis I, Makavos G, Lekakis J. Arterial stiffness and coronary artery disease. Curr Opin Cardiol. 2015;30(4):422-31
18. Williams B, Giuseppe M, Wilko S, Enrico A, Michel A, Michel B. 2018 ESC/ESH Guidelines for the management of arterial hypertension. European Heart Journal. 2018; 39:3021–104
19. Palmiero P, Maiello M, Daly DD Jr, Ciccone MM, Nanda NC. Aortic stiffness assessed by global pulse wave velocity in postmenopausal women: an ultrasonographic study. Echocardiography. 2012;29(10):1233-8.
20. Baguet, JP., Kingwell, B., Dart, A. et al. Analysis of the regional pulse wave velocity by Doppler: methodology and reproducibility. J Hum Hyperten. 2003;17, 407-12.
21. Franklin SS et al. Hemodynamic patterns of age-related changes in blood pressure. The Framingham Heart Study. Circulation. 1997;96(1):308–15.
22. Subbiah MT. Estrogen replacement therapy and cardioprotection: mechanisms and controversies. Brazilian Journal of Medical and Biological Research. 2002;35(3):271-6
23. Lyle AN, Raaz U. Killing Me Unsoftly: Causes and Mechanisms of Arterial Stiffness. Arterioscler Thromb Vasc Biol. 2017 Feb;37(2): e1-e11.
24. Yu-Jie W, Hui-Liang L, Bing L, Lu Z, Zhi-Geng J. Impact of smoking and smoking cessation on arterial stiffness in healthy participants. Angiology. 2013 May;64(4):273-80.
25. El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, Limacher MC, Manson JE, Stefanick ML, Allison MA; American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; and Council on Cardiovascular and Stroke Nursing. Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association. Circulation. 2020 Dec 22;142(25):e506-e532.
26. Salehi N, Janjani P, Tadbiri H, Rozbahani M, Jalilian M. Effect of cigarette smoking on coronary arteries and pattern and severity of coronary artery disease: a review. J Int Med Res. 2021. Dec; 49:12.
27. Hirofumi Ohnishi, Shigeyuki Saitoh, Satoru Takagi, Jun-ichi Ohata, Takeshi Isobe, Yuka Kikuchi, Hiroshi Takeuchi, Kazuaki Shimamoto; Pulse Wave Velocity as an Indicator of Atherosclerosis in Impaired Fasting Glucose: The Tanno and Sobetsu Study. Diabetes Care 1 February 2003; 26 (2): 437–440.
28. Sadeghi M, Heidari R, Mostanfar B, Tavassoli A, Roghani F, Yazdekhasti S. The Relation Between Ankle-Brachial Index (ABI) and Coronary Artery Disease Severity and Risk Factors: An Angiographic Study. ARYA Atheroscler. 2011 Summer;7(2):68-73.
29. Wohlfahrt P, Palouš D, Ingrischová M, et al. A high ankle-brachial index is associated with increased aortic pulse wave velocity: the Czech post-MONICA study. European Journal of Cardiovascular Prevention & Rehabilitation. 2011;18(6):790-796.
30. Choi KM, Lee KW, Seo JA, Oh JH, Kim SG, Kim NH, et al. Relationship between brachial-ankle pulse wave velocity and cardiovascular risk factors of the metabolic syndrome. Diabetes Res Clin Pract 2004;66:57-61.
31. Yamashina A, Tomiyama H, Arai T, Hirose K, Koji Y, Hirayama Y, et al. Brachial-ankle pulse wave velocity as a marker of atherosclerotic vascular damage and cardiovascular risk. Hypertens Res 2003;26:615-22.
Published
2026-06-11
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How to Cite
Yuliani, F., Elfi, E., Ilhami, Y., & Ali, H. (2026). The Difference Value of Global Pulse Wave Velocity between Type 2 Diabetic and Non-diabetic Patients with Chronic Coronary Syndrome. Indonesian Journal of Cardiology. https://doi.org/10.30701/ijc.1667
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Clinical Research
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