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Preserved vasodilator response to adenosine in insulin‐dependent diabetes mellitus
Author(s) -
RONGEN G. A.,
GINNEKEN E.,
THIEN Th.,
LUTTERMAN J. A.,
SMITS P.
Publication year - 1996
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1046/j.1365-2362.1996.110264.x
Subject(s) - medicine , adenosine , vasodilation , diabetes mellitus , hyperaemia , brachial artery , insulin , blood flow , endocrinology , forearm , cardiology , anesthesia , blood pressure , surgery
Experimental data derived from animal models suggest that the endogenous nucleoside adenosine has important cardioprotective properties. The potent vasodilator effects of adenosine may contribute to this cardioprotection as ischaemia‐induced release of endogenous adenosine has been suggested to adjust local blood flow to the metabolic demands of the tissue. Interestingly, the vascular effects of adenosine appeared to be impaired in animal models for diabetes mellitus. This observation may be of importance with respect to the increased cardiovascular mortality in diabetes. Therefore, the authors investigated the in vivo vasodilator effects of adenosine in insulin‐dependent diabetic patients. In 12 uncomplicated insulin‐dependent male diabetic patients and 12 healthy male age‐matched subjects, the brachial artery was cannulated for infusion of adenosine (0.15, 0.5, 1.5, 5, 15 and 50 μg 100 −1 mL min −1 ) and for measurement of mean arterial pressure (MAP). Forearm blood flow (FBF) was measured by venous occlusion mercury‐in‐silastic strain gauge plethysmography. Maximal vasodilatation was assessed by standardized post occlusive reactive hyperaemia (PORH). Baseline forearm blood flow was 2.7 ± 0.4 and 1.8 ± 0.2 0.2 mL 100 −1 mL min −1 for the diabetic patients and control group respectively. In the diabetic patients, adenosine infusion raised forearm blood flow to 2.4 ± 0.4, 2.6 ± 0.4, 4.4 ± 0.7, 6.3 ± 1.0, 9.8 ± 1.5 and 14.2 ± 2.1 mL 100 −1 mL min −1 for the respective dosages. In the control group these values were 1.7 ± 0.21, 1.9 ± 0.3, 3.2 ± 0.8, 6.0 ± 1.2, 10.9 ± 2.1 and 17.1 ± 3.4 mL 100 −1 mL min −1 respectively ( P > 0.1 for between group comparison). Forearm blood flow at the contralateral side was not significantly affected by the placebo and adenosine infusions. Similar results were obtained when results were expressed as changes in forearm vascular resistance or forearm blood flow ratio (FBF infused arm/FBF control arm). Maximal vasodilatation did not differ between the two groups. The authors conclude that the forearm vasodilator response to adenosine is preserved in uncomplicated insulin‐dependent diabetic patients. This observation argues against a primary role of a reduced adenosine responsiveness in the cardiovascular sequelae of diabetes.