Impaired glucose metabolism and type 2 diabetes are associated with hypercoagulability: potential role of central adiposity and low-grade inflammation--the Hoorn Study |
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Authors: | Beijers Hanneke J B H Ferreira Isabel Spronk Henri M H Bravenboer Bert Dekker Jacqueline M Nijpels Giel ten Cate Hugo Stehouwer Coen D A |
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Institution: | a Department of Medicine, Catharina Hospital, Eindhoven, the Netherlandsb Department of Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlandsc Department of Clinical Epidemiology and Medical Technology Assessment, MUMC+, Maastricht, the Netherlandsd Cardiovascular Research Institute Maastricht (CARIM), MUMC+, Maastricht, the Netherlandse Care and Public Health Research Institute (CAPHRI), MUMC+, Maastricht, the Netherlandsf Laboratory for Clinical Thrombosis and Hemostasis, MUMC+, Maastricht, the Netherlandsg EMGO Institute for Health and Care Research (EMGO+), VU Medical Centre, Amsterdam, the Netherlands |
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Abstract: | IntroductionType 2 diabetes (DM2) is associated with greater risk for cardiovascular disease (CVD), which may, at least partially, be explained by prothrombotic alterations. We therefore investigated; first, the extent to which individuals with impaired glucose metabolism (IGM) and/or DM2 had greater levels of thrombin generation than those with normal glucose metabolism (NGM); and second, whether any differences were independent of other cardiovascular risk factors, such as smoking, hypertension, dyslipidaemia, (micro)albuminuria, glycemic control and (central) adiposity, and/or were potentially ‘mediated’ by low-grade inflammation (high-sensitivity C-reactive protein (hsCRP)).Materials and methodsWe studied 744 individuals from the Hoorn Study (275 NGM, 176 IGM and 293 DM2, mean age 68.6 ± 7.1 years). Thrombin generation in platelet-poor plasma was measured using the Calibrated Automated Thrombogram and three parameters were derived: lag time, peak height and endogenous thrombin potential (ETP). Data were analyzed with multiple linear regression analyses.ResultsAfter adjustment for age, sex, prior CVD and smoking status, individuals with IGM or DM2 had a longer lag time ß = 0.14 min (95% CI: 0.02; 0.26)], higher peak height ß = 7.29 nM (− 1.33; 15.91)] and ETP ß = 35.65nM*min (0.97; 70.34)] than those with NGM. These differences were attenuated to ß = 0.06 min (− 0.07; 0.19), 3.82 nM (− 5.46; 13.10) and 16.34 nM*min (− 20.92; 53.59), respectively, when further adjusted for waist circumference and hsCRP.ConclusionIndividuals with IGM or DM2 had up to 4% higher thrombin generation compared with NGM, which may be explained, to a great extent, by the greater levels of central adiposity and related low-grade inflammation characterizing these individuals. |
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Keywords: | ANOVA analysis of variance BMI body mass index CAT calibrated automated thrombogram CV coefficient of variation CVD cardiovascular disease DBP diastolic blood pressure DM2 Diabetes Mellitus type 2 ETP endogenous thrombin potential HDL high-density lipoprotein hsCRP high-sensitivity C-reactive protein IGM impaired glucose metabolism LDL low-density lipoprotein NGM normal glucose metabolism PAI-1 plasminogen activator inhibitor 1 PPP platelet poor plasma SBP systolic blood pressure SPSS Statistical Package for Social Sciences TAT thrombin-antithrombin complexes TF tissue factor TFPI tissue factor pathway inhibitor |
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