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Fonction endothéliale et rigidité artérielle, deux intégrateurs du risque cardiovasculaire : Etude à jeun et pendant la période post prandiale chez le sujet sain et le diabétique de type 2

Abstract : Introduction : The primary objective of this thesis was to study, at fasting and during the postprandial period, cardiovascular risk integrators in subjects representing the continuum from normoglycemia to insulin treated type 2 diabetes. We studied the following parameters : endothelial function, arterial stiffness and autonomic nervous system. Methods We have (i) conducted a metabolic study in obese subjects with continuous glucose monitoring systems ; (ii) studied subjects with normal glycemia (NUTRIVASC: NCT01579409), impaired glucose tolerance (ACCESS : NCT01521312) and (iii) type 2 diabetes before and after insulin treatment (INSUVASC: 01022658) ; and finally (iv) we studied the association of arterial stiffness with hepatic fibrosis and with diabetic neuropathy. Results(i) Glucose variability was higher in the presence of dysglycemia and increased with HbA1c. The kinetics of oral glucose tolerance test compared to a standardized breakfast were well correlated. (ii) In elderly patients without cardiovascular risk factors, the post-prandial increase in cardiac output depended on the increase in heart rate which was not driven by cardiac vagal inhibition ; The French National Nutrition Program recommendations had favorable effects on heart rate and myocardial viability. (iii) A 4-week treatment with insulin in addition to metformin improved microvascular endothelial function at fasting. (iv) In normotensive patients with diabetes, those with peripheral neuropathy have a two-fold higher risk for increased arterial stiffness than those without neuropathy. Finally, liver fibrosis correlates with arterial stiffness independently of age and blood pressure in normotensive subjects. Conclusions : Our work underlines the importance of exploring cardiovascular integrators during post prandial period in healthy subjects and in diabetic patients, according to their diet and their hypoglycemic and anti-hypertensive treatments.
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Marinos Fysekidis. Fonction endothéliale et rigidité artérielle, deux intégrateurs du risque cardiovasculaire : Etude à jeun et pendant la période post prandiale chez le sujet sain et le diabétique de type 2. Cardiologie et système cardiovasculaire. Université Sorbonne Paris Cité, 2016. Français. ⟨NNT : 2016USPCD032⟩. ⟨tel-01871598⟩

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