Circulating CD34-Positive Cell Number Is Associated With Brain Natriuretic Peptide Level in Type 2 Diabetic Patients

Patients with type 2 diabetes often suffer from asymptomatic left ventricular (LV) injury, including increased LV mass, without apparent myocardial ischemia. The mechanisms underlying diabetic LV injury remain unclear; however, it has been suggested that endothelial dysfunction plays a role. Accumulating evidence indicates that bone marrow–derived endothelial progenitor cells (EPCs) contribute to neovascularization of ischemic tissue and endothelialization of denuded endothelium. Recent studies have shown that circulating bone marrow–derived immature cells, including CD34+ cells, contribute to the maintenance of the vasculature, both as a pool of EPCs and as the source of growth/angiogenesis factors (1). We hypothesized that circulating CD34+ cells might be associated with LV dysfunction in patients with type 2 diabetes. Therefore, we studied the correlation between circulating CD34+ cell levels and plasma brain natriuretic peptide (BNP) levels, an LV dysfunction marker, in type 2 diabetic patients. The institutional review board of the National Cardiovascular Center approved this study, and all subjects provided informed consent. We examined 26 patients with type 2 diabetes (12 men and 14 women, duration of diabetes 16.1 ± 10.7 years) who were over 60 years of age (70.5 ± 6.4 years). Statin was given to nine subjects. ACE inhibitor or angiotensin receptor blocker was given to nine subjects, and thiazolidinedione was given to two subjects. Subjects were excluded from the study if they had known cardiovascular disease or chronic renal failure (defined as serum creatinine ≥180 μmol/l). No study subject showed hypokinesis by echocardiography or electrocardiogram change, indicating myocardial ischemia. …