Is there an association between glomerular hyperfiltration and coronary flow velocity reserve in patients with gestational diabetes history?

Abstract

Glomerular hyperfiltration (GHF) is an early marker of chronic kidney disease (CKD) and may predict coronary microvascular dysfunction, presenting as reduced coronary flow velocity reserve (CFVR) in patients with a history of gestational diabetes (GDM). This study aimed to assess the glomerular filtration rate (GFR) and compare CFVR in patients with a history of GDM. We screened patients referred to the Cardiology Department of Istanbul Medeniyet University for angina pectoris, excluding those with positive treadmill test results. Women with a history of GDM were categorized into three groups based on GFR levels: Group 1 (60-89 ml/min), Group 2 (90-119 ml/min), and Group 3 (≥ 120 ml/min). Coronary diastolic peak velocities were measured at baseline and after dipyridamole administration, with CFVR defined as the ratio of hyperemic to baseline diastolic peak velocities. The homeostasis model assessment of insulin resistance (HOMA-IR) and body mass index were derived from patient files. A total of 166 patients were included: 57 in Group 1, 80 in Group 2, and 29 in Group 3. HOMA-IR was higher in Group 3 compared to Group 2 (P < 0.05). Group 1 had the lowest CFVR (2.3 ± 0.3%), Group 2 had the highest (2.5 ± 0.3%), and Group 3 showed a moderate decrease in CFVR (2.4 ± 0.3%). Multivariate linear regression analysis revealed that HbA1c was independently associated with CFVR. In patients with GDM, GHF is associated with reduced CFVR, linked to metabolic parameters such as HbA1c and HOMA-IR. Interventions to improve metabolic health may prevent cardiovascular disease in these patients.

Keywords

• Gestational diabetes
• glomerular hyperfiltration
• coronary flow velocity reserve
• endothelial dysfunction