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Reduced aortic wall stress in diabetes mellitus
Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences.
Department of Clinical Sciences, Malmö, Lund University, Sweden.
Department of Clinical Sciences, Malmö, Lund University, Sweden.
Department of Surgery, Helsingborg Hospital, Sweden.
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2007 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, Vol. 33, no 5, 592-598 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Most risk factors are similar for abdominal aortic aneurysm (AAA) and atherosclerosis, e.g. smoking, male gender, age, high blood pressure, hyperlipidemia. Diabetes mellitus however, is a risk factor for atherosclerosis, but diabetic patients seldom develop AAA. The reason for this discrepancy is unknown. Increased aortic wall stress seems to be an etiologic factor in the formation, growth and rupture of AAA in man. The aim of our study was to study the wall stress in the abdominal aorta in diabetic patients compared with healthy controls.

Methods: 39 patients with diabetes mellitus and 46 age – and sex matched healthy subjects were examined with B-mode ultrasound to determine the lumen diameter (LD) and intima-media thickness (IMT) in the abdominal aorta (AA) and the common carotid artery (CCA). Diastolic blood pressure (DBP) was measured non-invasively in the brachial artery. LaPlace law was used to calculate circumferential wall stress.

Results: Age, DBP, and LD in the abdominal aorta were not significantly different in the diabetic patients compared to controls. IMT in the AA was larger in the diabetic patients, 0.89 ± 0.17 vs 0.73 ± 0.11 mm (p < .001). Accordingly aortic wall stress was reduced in the diabetics, 7.8 ± 1.7 × 105 vs 9.7 ± 1.9 × 105 dynes/cm2 (p < .001).

Conclusions: Wall stress in the abdominal aorta is reduced in diabetes mellitus. This is mainly due to a thicker aortic wall compared to healthy controls. The reduced aortic wall stress coincides with the fact that epidemiological studies have shown a decreased risk of aneurysm development in diabetic patients.

Place, publisher, year, edition, pages
2007. Vol. 33, no 5, 592-598 p.
Keyword [en]
Abdominal aorta, Diabetes mellitus, Intima-media thickness, Wall stress, Wall tension, Aneurysm
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-13181DOI: 10.1016/j.ejvs.2006.11.011OAI: diva2:17985
Available from: 2008-04-14 Created: 2008-04-14 Last updated: 2009-08-21
In thesis
1. Regulation of aortic wall mechanics and stress: An experimental study in man
Open this publication in new window or tab >>Regulation of aortic wall mechanics and stress: An experimental study in man
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The abdominal aorta (AA) in man is a vulnerable artery prone to atherosclerosis as well as aneurysmatic dilation. The underlying aortic composition, mechanical properties as well as the mechanisms responsible for age-related changes and vascular disease are however largely unknown. The aims of this study were 1) to characterize the age- and gender-related changes of the aortic wall components in vivo, using a mechanical model based on ultrasound measurements of pulsatile aortic diameter changes combined with intra-arterial pressure; 2) to validate ultrasound measurements of diameter and intima-media thickness (IMT) of the AA in order to calculate wall stress; 3) to study the stress driven remodeling response of the aortic wall in healthy individuals and the influence of age and gender; and 4) to study wall stress and remodeling of the AA in diabetic patients in order to elucidate the protective influence of diabetes on abdominal aortic aneurysm formation.

The stiffness of the isotropic material (mainly elastin) increased in males despite the known decrease in elastin content with age. Further, an exponential increase in stiffness of the anisotropic material (mainly collagen) in males at high physiological pressure was found. This might be due to changed isoforms of collagen and increased glycation with age. Females were less affected than males.

The reproducibility of the ultrasound measurements of diameter and IMT in the AA was acceptable (CV; 4% and 11% respectively), making it possible to calculate circumferential aortic wall stress in vivo. The age-related remodeling of the arterial wall led to increased diameter, and compensatory thickening of the wall preventing the circumferential wall stress from increasing in the common carotid artery of males and females, and the AA of females. However, the compensatory increase in wall thickness was defect in the male AA, where stress increased with age. Pulsatile stress influenced the material parameters of the AA, leading to increased stiffness of anisotropic material (mainly collagen), whereas stiffness of isotropic material (mainly elastin) was unaffected.

Patients with diabetes mellitus had increased aortic wall thickness than controls, generating less circumferential stress. This coincides with the known reduction of abdominal aortic aneurysms in diabetic patients and may act as a protective factor.

Place, publisher, year, edition, pages
Institutionen för medicin och hälsa, 2008. 74 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1053
Aorta, wall stress, remodeling, IMT, gender, diabetes mellitus, aging, collagen, elastin
National Category
urn:nbn:se:liu:diva-11556 (URN)978-91-7393-944- 7 (ISBN)
Public defence
2008-05-16, Originalet, Qulturum, Hus B4, Länssjukhuset Ryhov, Jönköping, 09:00 (English)
Available from: 2008-04-14 Created: 2008-04-14 Last updated: 2009-08-22

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Åstrand, HåkanLänne, Toste
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Physiology Faculty of Health SciencesDepartment of Thoracic and Vascular Surgery
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