Glucose, insulin, diabetes and mechanisms of arterial dysfunction.

1. This commentary reviews and discusses the association between increased arterial stiffness and indices of glucose and insulin metabolism and diabetes mellitus (DM). 2. Diabetes mellitus is associated with increased cardiovascular events, is an established major independent risk factor for cardiovascular disease and is included in current risk assessment algorithms. Based on Framingham risk assessment, the incremental risk due to DM, at a given level of baseline risk in non-diabetics, is approximately equivalent to 10 years and, at any given level of other major risk factors, DM increases risk three- to fourfold. 3. Increased aortic stiffness has been shown to be an independent risk factor for both cardiovascular and overall mortality in high-risk groups and recently in the general population. Both DM1 and DM2 are associated with accelerated stiffening of the elastic arteries, over and above that associated with normal ageing, and DM can be considered as imparting added biological age and, thus, added cardiovascular risk. 4. Aortic stiffness provides a plausible mechanism relating diabetes to increase cardiovascular disease. 5. A proportion of the increased risk of cardiovascular events in DM is a sequel of stiff arteries. Direct measures of arterial stiffness, such as aortic pulse wave velocity, are likely to be better candidates than pulse wave analysis for refining interventions to improve outcomes in diabetes.