Carotid Intima Medial Thickness as A Surrogate Marker for Systemic Atherosclerosis in Type 2 Diabetes Mellitus

Background: The objective was to measure the correlation between carotid intima medial thickness (CIMT) with duration of type 2 diabetes mellitus (DM) and its correlation with biochemical markers and body mass index (BMI). Methods: The study was conducted in a tertiary care hospital in Kolkata. Total 100 patients were selected randomly who met the inclusion criteria. Among total patients, 20 cases were newly detected type 2 DM patients and 80 were cases of established diabetes, with different duration of DM. CIMT was measured by carotid artery ultrasonography using an echo tomography system having midfrequency of 7.5MhZ and detection limit of 0.1mm. Duration of diabetes was measured as present age minus age of detection of DM. BMI was measured by the guideline of WHO. The parameters were estimated such as microalbuminuria by radioimmunoassay, fasting blood sugar (FBS) level and HbA1C by HPLC method, uric acid by uricase method. Data was collected using a predetermined proforma and statistical analyses were done. Results: Duration of DM was positively correlated with CIMT and association was statistically significant (P<0.02). There was increase in CCA-IMT and ICA-IMT across increasing level of FBS and HbA1c (P<0.01). Microalbuminuria is considered a novel atherosclerotic risk factor, was found significantly associated with mean CIMT (P<0.001). CIMT was also significantly associated with HbA1C (P<0.001). The significantly (P<0.01) increased level of uric acid indicated higher carotid plaque. Conclusion: CIMT is an objective measure of subclinical atherosclerosis, which is a non- invasive, less expensive, duration and reproducible way of demonstrating subclinical atherosclerosis. Thus, it can serve as a window for atherosclerosis status in other major arteries like coronary artery and cerebral arteries. The CIMT is closely associated with several markers viz. uric acid, blood sugar, HbA1c, albumin and BMI during the progression of type 2 DM.

Relationship between clinical course and measures of atherosclerosis in diabetic foot / 대한내과학회지

BACKGROUND: Although various factors may influence the outcome of diabetic foot ulcers in diabetic subjects, the severity of peripheral vascular disease (PVD) is the main independent risk factor for amputation. The carotid intima-medial thickness (IMT), ankle brachial pressure index (ABPI) and pulse wave velocity (PWV) have been used as noninvasive markers of PVD. The present study aims to examine the association of carotid IMT, ABPI and PWV with the risk of lower extremity amputation in diabetic foot patients. METHODS: Total 114 diabetic patients (39 diabetic foot patients and 75 patients who didn't have diabetic foot) were participated for the study. Twenty four of diabetic foot patients underwent lower extremity amputation. Informations about past history, social habit and courses of diabetic foot were collected from the patients by means of a structured interview. We measured carotid IMT, ABPI and PWV. RESULTS: The following characteristics were significantly related to the development of diabetic foot ulcers: male, smoker, alcohol drinker, longer diabetes duration, presence of diabetic chronic complications, lower ABPI (0.8 mm), increased PWV. Patients with amputation had lower HDL cholesterol, higher incidence of osteomyelitis and older age, compared with patients without amputation. We observed a significant association between mean carotid IMT and the rate of amputation in diabetic foot patients [odd ratio, 11.42 (95% confidence interval, 1.03~127.19)]. CONCLUSIONS: This study suggests that measurement of carotid IMT as noninvasive index of atherosclerosis may be a useful indirect method in identifying diabetic foot patients who may have lower extremity amputation.

Relationship between Plasma Leptin Levels and Carotid Intima-Medial Thickness in Korean Adults / 대한내분비학회지

BACKGROUND: Many studies have recently shown that leptin can promote angiogenesis via endothelial leptin receptors and induce oxidative stress in endothelial cells; These findings suggest the relationship between cardiovascular risk and blood leptin concentration. In the present study, we investigated the relationship between leptin concentration and carotid intima-medial thickness (CIMT) as an indicator of early atherosclerosis in adults. METHEODS: The study subjects comprised 138 (45 men and 93 women; mean age 42.4+/-7.5 years; mean BMI 24.0+/-2.7 kg/m2) without history of diabetes, hypertension or cardiovascular disease. We measured CIMT by high resolution ultrasonography and plasma leptin levels by radioimmunoassay. RESULTS: 1) No significant differences in age, BMI or CIMT between male and female subjects were noted, but the leptin levels in female were significantly higher than those in males. (8.42+/-5.90 ng/mL vs. 3.08+/-1.00 ng/mL, p<0.001) 2) CIMT showed a significant positive correlation with age (r=0.31, p< 0.001), BMI (r=0.25, p<0.01) and level (r=0.42, p<0.05) in simple regression analysis. 3) When male and female subjects were each divided into 3 groups by leptin concentration, no significant difference in CIMT among female subjects was found. In male subjects, CIMT was significantly higher in the highest tertile of leptin level than in the other 2 groups (0.65+/-0.03 mm vs. 0.56+/-0.07 mm and 0.53+/-0.07 mm, p<0.01) after adjustment for BMI and age. However, this difference was not significant after adjustment for smoking. 4) CIMT (0.61+/-0.05 mm vs. 0.53+/-0.07 mm, p<0.01) and leptin concentrations (3.57+/-2.13 ng/mL vs. 2.20+/-1.39 ng/mL, p<0.05) were significantly higher in male smokers than in male non-smokers. CONCLUSION: Our results demonstrated significant correlation of CIMT to plasma leptin level before adjustment for smoking. A possible explanation is the permissive action of smoking on the atherogenic effect of leptin. However, further studies to elucidate the relationships and interactions among smoking, leptin level and the development of atherosclerosis will be needed.

The comparison of artery intima-medial thickness between latent autoimmune diabetes in adults and type 2 diabetes / 中国实用内科杂志

0.05).In LADA patients,multipe linear regression analysis showed that the risk factors related to the intima media thickness of common carotid artery were age,smoking and LDL-C and the risk factors related to the intima medial thickness of femoral artery were age,sex and LDL-C.Conclusion The prevalence of subclinical atherosclerosis between LADA and type 2 diabetes is similar.LDL-C,age,sex and smoking may be the risk factors of subclinical AS in LADA patients.

Relationship of Dehydroepiandrosterone Sulfate, Sex Hormone Binding Globulin and Carotid Atherosclerosis in Women / 대한내분비학회지

BACKGROUND: Cardiovascular disease is the major cause of morbidity and mortality. It is well known that androgen and sex hormone-binding globulin(SHBG) in women were associated with risk factors for cardiovascular disease such as obesity, central fat accumulation and atherogenic lipid profile. High resolution B-mode ultrasonography can visualize directly both luminal and vessel wall characteristics, and ultrasonic measurement of carotid intima-medial thickness(IMT) can be used to investigate the atherosclerosis of coronary, cerebral and peripheral arteries. The aim of this study was to evaluate the relationship between the serum dehydroepiandrosterone sulfate(DHEA-S) and SHBG, and body fat distribution pattern, cardiovascular risk factor and carotid atherosclerosis in women. METHODS: Blood pressure, fasting serum glucose, insulin, lipid profile, SHBG and DHEA-S were measured. Body fat distribution pattern was assessed by waist to hip ratio, waist to thigh ratio and subscapular to triceps skin fold thickness ratio, faf mass measured by bioelectric impedance analyzer, subcutaneous fat area, visceral fat area, and visceral to subcutaneous fat area ratio(VSR) at the level of umbilicus using the computed tomography. The IMT of the carotid artery was measured by high resolution B mode ultrasound as a marker of atherosclerosis. RESULTS: 1) There was no significant difference of age-adjusted values of carotid IMT among subjects with NGT(0.426+/-0.09mm), IGT(0.46+/-10.09mm) and NIDDM(0.453+/-0.11mm). 2) In postrnenopausal women, carotid IMT was greater(0.484+/-0.11mm, p=0.05) than premenopausal women(0.426+/-0.08mm), but it was not significant after age adjustment. Serum SHBG and DHEA-S levels in postmenopausal women were significantly lower(p<0.05) than premenopausal women, but they were not significant after age adjustment. 3) Carotid IMT was significantly correlated with age(r=0.37, p<0.01), fasting serum glucose (r=0.32, p<0.01), total cholesterol(r= 0.25, p<0.05), LDL-cholesterol(r=0.26, p<0.05), visceral fat area(r=0.35, p<0.01) and VSR(r=0.31, p<0.05). 4) By the stepwise multiple regression analysis, carotid IMT was positively and significantly associated with age(p<0.01) and serum DHEA-S concentration(p<0.05) in dent of age, body mass index, waist to hip ratio, fasting serum glucose. CONCLUSION: Carotid IMT was associated with age and serum DHEA-S concentration in women without cardiovascular disease. Therefore, serum DHEA-S may be one of risk factors for cardiovascular disease in women. However, we could not conclude its cause-result relationship because of cross sectional nature of our study, and prospective study will be needed.