Assessment of Vascular and Metabolic Changes in Post-menopausal Women With Type 2 Diabetes Mellitus

Introduction Complications of diabetes, such as cardiovascular disease, are associated with increased mortality among type 2 diabetes mellitus patients. The presence of type 2 diabetes mellitus (T2DM) also increases the relative risk of developing cardiovascular disease in women compared to men . Major cardiovascular disease risk factors that have been identified in T2DM patients include arterial stiffening, endothelial dysfunction, hyperglycemia , and elevated glycated haemoglobin (HbA1c) concentrations.

Cardiovascular disease is the major cause of morbidity and mortality in T2 DM, due to arterial structure and functional changes. Evaluation of vascular dysfunction in T2 DM patients include: carotid intima media thickness (IMTc), pulse wave velocity (PWV), and brachial artery flow-mediated dilation (FMD). IMTc is increased in patients with T2 DM with reductions in FMD, which have already been reported to be inversely and strongly related to the extent of hyperglycemia.

The incidence of vascular complications is multifactorial and may not be explained by hyperglycemia alone. Other presumably unrelated risk factors, such as hyperhomocysteinemia may be involved in the atherothrombotic process. High levels of homocysteine have been identified as a risk factor for cardiovascular disease in T2DM patients. Levels of plasma homocysteine increase in women after menopause, and postmenopausal diabetic women are consequently at significantly increased risk of cardiovascular disease.

High concentrations of homocysteine are associated with increased low-density lipoprotein oxidation, endothelial dysfunction, dysfunction of β-islet cells and inhibiting secretion of insulin. Also, hyperhomocysteinemia was an independent risk factor for the occurrence of diabetic peripheral neuropathy .

In newly diagnosed normotensive T2DM patients, the left ventricular mass index (LVMI), carotid intima media thickness (CIMT), and creatinine levels and 24-hr microalbuminuria were used to determine cardiac, carotid, and kidney end-organ diseases, respectively. It was found that, LVMI, CIMT, and creatinine level were positively correlated with the homocysteine level.