Relationship between the reactivity of skin microcirculation and risk of cardiovascular disease in patients with diabetes mellitus

Background: It is suggested that microcirculation disorders play an important role in the pathogenesis of cardiovascular diseases, including in patients with diabetes mellitus. Aims: The purpose of this research is to study the relationship between skin microcirculation disorders and the risk of cardiovascular diseases in diabetic patients. Materials and methods: Study subjects included patients with diabetes mellitus aged 30 to 74 years without established cardiovascular diseases (angina pectoris, chronic heart failure, history of myocardial infarction, history of stroke, peripheral artery diseases). The reactivity of skin microcirculation was assessed by laser Doppler flowmetry during a heating test. Based on the median of a microcirculation growth, the subjects were divided into two subgroups: the subgroup of patients with “high” and the subgroup of patients with “low” reactivity of microcirculation. The 10-year cardiovascular risk was assessed using the Framingham Score (modification of 2008). Results: The subgroup of patients with “high” reactivity of microcirculation (n=21; median age 55 [40; 59]; 18 females; 3 males) and the subgroup of patients with “low” reactivity (n = 21; median age 60 [54; 64]; 14 females; 7 males) were comparable in sex, body mass index, smoking status, type of diabetes, microcirculatory complications of diabetes, diabetes duration, glycated hemoglobin level, total cholesterol level, high-density lipoprotein level (p>0.05 for all comparisons). Patients with “high” microcirculation reactivity had significantly lower 10-year risk of the first cardiovascular disease, estimated according to Framingham score, than the subgroup of patients with “low” microcirculation reactivity (13.9 [8.8; 22.9] % and 27.4 [18.7; 35.1] %, respectively; p = 0.012). Conclusions: Reduced reactivity of skin microcirculation during heating is associated with increased risk of cardiovascular diseases in patients with diabetes mellitus. Evaluation of skin microcirculation in prospect may improve the accuracy of cardiovascular disease prediction in diabetic patients and may be considered as an additional cardiovascular risk factor.