The scope of this thesis is the application of non-invasive vascular measurements in two
conditions characterised by prevalent vascular disease, diabetes mellitus and dyslipidemia.
Functional vascular abnormalities are found very early in both diabetes mellitus and
dyslipidemia, but it may take decades before clinical manifestations become apparent,
and even then, in only part of these patients. Metabolic data, like glycemic or lipidemic
history and status, provide limited predictive power for the risk of clinical vascular disease
in an individual patient. Genetic characteristics may have some additive predictive value
in future, but monitoring of the functional and structural vascular condition may yet be
the most feasible tool to predict the risk for clinical events and form the best guide for
interventions. It may also give direct information on the pathophysiology of vascular
disease.
This thesis shows that a classical non-invasive vascular method, ankle pressure
measurement, is insufficient to monitor the effects of an intervention (chapter 5). Another
non-invasive vascular measurement method, the intima-media thickness (IMT), has been
extensively used for this purpose in lipidJowering studies, and is reviewed in chapter 7
and 8. In chapter 6 the effects on the IMT are compared of initial and long-term lipidlowering therapy in dyslipidemia. The IMT method is also used to detect early structural
vascular abnormalities in patients with glycogen storage disease Ia, expected to be
particularly prone to cardiovascular disease (chapter 9). The IMT may serve as a mirror
of the final common pathway of atherosclerosis of large arteries, but provides little insight
in pathophysiologic changes. To this end, in chapters 2-4, a new bio-impedance method
is used to compare various properties of an upper arm vascular bed, as blood volume,
compliance and distensibiliry in diabetic patients and control subjects. Apart from changes
in arterial compliance and distensibiliry the method also illustrates venous abnormalities
in diabetes. Several results fit the hemodynamic angiopathic hypothesis. One of the
studies also provides preliminary results on the predictive value of some vascular parameters
in developing long-term vascular complications.