Open Access Open Badges Original investigation

Impact of ADMA, endothelial progenitor cells and traditional cardiovascular risk factors on pulse wave velocity among prediabetic individuals

Ioannis Protopsaltis1*, Stefanos Foussas2, Angeliki Angelidi1, Angelos Gritzapis3, Theodoros Ν Sergentanis4, Spyros Matsagos5, Konstantinos Tzirogiannis1, Georgios I Panoutsopoulos6, Georgios Dimitriadis7, Sotirios Raptis8 and Andreas Melidonis1

Author Affiliations

1 Diabetes Center, Tzanio General Hospital of Piraeus, Zanni and Afendouli 1, Piraeus, 18537, Greece

2 Department of Cardiology, Tzanio General Hospital of Piraeus, Piraeus, Greece

3 Laboratory of Cellular Biology and Immunology, Locus Medicus S.A, Athens, Greece

4 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National University of Athens, Athens, Greece

5 Blood Bank Service, Tzanio General Hospital of Piraeus, Piraeus, Greece

6 Department of Nursing, University of Peloponnese, Sparta, Greece

7 2nd Department of Internal Medicine, Research Institute and Diabetes Center, ‘Attikon’ University General Hospital, Athens, Greece

8 Hellenic National Diabetic Centre, Athens, Greece

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Cardiovascular Diabetology 2012, 11:141  doi:10.1186/1475-2840-11-141

Published: 15 November 2012



Central arterial stiffness represents a well-established predictor of cardiovascular disease. Decreased circulating endothelial progenitor cells (EPCs), increased asymmetric dimethyl-arginine (ADMA) levels, traditional cardiovascular risk factors and insulin resistance have all been associated with increased arterial stiffness. The correlations of novel and traditional cardiovascular risk factors with central arterial stiffness in prediabetic individuals were investigated in the present study.


The study population consisted of 53 prediabetic individuals. Individuals were divided into groups of isolated impaired fasting glucose (IFG), isolated impaired glucose tolerance (IGT) and combined IGT-IFG. Age, sex, family history of diabetes, smoking history, body mass index (BMI), waist to hip ratio (WHR), waist circumference (WC), blood pressure, lipid profile, levels of high sensitive C-reactive protein (hsCRP), glomerular filtration rate (GFR), and history of antihypertensive or statin therapy were obtained from all participants. Insulin resistance was evaluated using the Homeostatic Model Assessment (HOMA-IR). Carotid -femoral pulse wave velocity was used as an index of arterial stiffness. Circulating EPC count and ADMA serum levels were also determined.


Among studied individuals 30 (56.6%) subjects were diagnosed with isolated IFG, 9 (17%) with isolated IGT (17%) and 14 with combined IFG-IGT (26.4%). In univariate analysis age, mean blood pressure, fasting glucose, total cholesterol, LDL cholesterol, and ADMA levels positively correlated with pulse-wave velocity while exercise and GFR correlated negatively. EPC count did not correlate with PWV. In multivariate stepwise regression analysis PWV correlated independently and positively with LDL-Cholesterol (low density lipoprotein) and ADMA levels and negatively with exercise.


Elevated ADMA and LDL-C levels are strongly associated with increased arterial stiffness among pre-diabetic subjects. In contrast exercise inversely correlated with arterial stiffness.

Pre-diabetes; ADMA; Pulse wave velocity; Endothelial progenitor cells