Risk factors for asymptomatic atherosclerosis in Japanese type 2 diabetic patients without diabetic microvascular complications* 1 (original) (raw)
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Subclinical Carotid Atherosclerosis in Asymptomatic Subjects With Type 2 Diabetes Mellitus
The Journal of cardiovascular nursing, 2015
Subjects with type 2 diabetes mellitus are considered to be at high risk for cardiovascular disease. The identification of carotid atherosclerosis is a validated surrogate marker of cardiovascular disease. Nurses are key professionals in the improvement and intensification of cardiovascular preventive strategies. The aim is to study the presence of carotid atherosclerosis in a group of asymptomatic subjects with type 2 diabetes mellitus and no previous clinical cardiovascular disease. A total of 187 patients with type 2 diabetes mellitus and 187 age- and sex-matched subjects without type 2 diabetes mellitus were studied in this cross-sectional, observational, cohort study. Standard operational procedures were applied by the nursing team regarding physical examination and carotid ultrasound assessment. Common, bulb, and internal carotid arteries were explored by measuring intima-media thickness and identifying atherosclerotic plaques. Carotid intima-media thickness (c-IMT) and caroti...
Diabetes and Progression of Carotid Atherosclerosis: The Insulin Resistance Atherosclerosis Study
Arteriosclerosis, Thrombosis, and Vascular Biology, 2003
Objective-We sought to determine the rate of progression of carotid atherosclerosis in persons with normal glucose tolerance, impaired glucose tolerance, and undiagnosed and diagnosed type 2 diabetes. Methods and Results-The Insulin Resistance Atherosclerosis Study (IRAS) is an observational cohort study in which 1192 men and women were examined at a 5-year interval. Participants of 3 ethnic groups (non-Hispanic white, African American, and Hispanic) were selected from the general population to represent a range of glucose tolerance. Baseline and follow-up ultrasound studies were obtained to estimate progression of common carotid artery (CCA) and internal carotid artery (ICA) intimal-medial thickness (IMT). Baseline glucose tolerance status was defined by an oral glucose tolerance test and World Health Organization criteria. In persons with normal glucose tolerance, progression of CCA IMT was 3.8 m/y, and ICA IMT, 17.7 m/y. In both CCA and ICA, progression of IMT, unadjusted for cardiovascular disease (CVD) risk factors, was approximately twice the rate in persons with diabetes than in those with normal or impaired glucose tolerance. Adjustment for CVD risk factors attenuated these differences somewhat in both sites of the carotid artery. Persons with undiagnosed diabetes had a greater ICA IMT progression rate than did persons with diagnosed diabetes (33.9 m/y vs 26.6 m/y, PϭNS). Progression rates did not differ between persons with normal and impaired glucose tolerance.
Journal of Evolution of Medical and Dental Sciences, 2016
BACKGROUND Atherosclerosis is a leading cause of mortality in developed and developing nations. It forms the major determinant in the reduction of volume of vascular lumen in various parts of the blood vessel. Atherosclerosis and diabetes mellitus has major relations. Diabetic population is expected to reach an epidemic proportion not only in India but in many countries around the world which in turn has greatly accelerated the risk for cardiovascular diseases and early mortality. In another two decades, cardiovascular diseases complicated by atherosclerosis will be the major cause of death. Carotid intimal medial thickness measurement can serve as an early predictor of subclinical atherosclerosis. The purpose of this study was to evaluate the usefulness of measuring Carotid intimal medial thickness (CIMT) in predicting the subclinical atherosclerosis. AIMS AND OBJECTIVES To estimate subclinical atherosclerosis in patients with type 2 diabetes mellitus by measuring the carotid intimal medial thickness. To study the association of age, sex, body mass index, smoking, alcohol, duration of diabetes, hypertension, fasting hyperglycaemia, serum total cholesterol with the carotid intimal medial thickness. MATERIALS AND METHODS This study was carried out in a tertiary care hospital over a period of 6 months after obtaining Institutional Ethical Committee approval. Fifty patients who presented with history of type 2 diabetes mellitus (diagnosed according to the ADA 2014 criteria) to OPDs and admitted in wards and who fulfilled the inclusion criteria were included in the study. Patients were subjected to symptom analysis, clinical examination, BP recording in all 4 limbs, examination of all peripheral pulses, height and weight and BMI calculation. Baseline laboratory investigations, resting 12-lead ECG, and CIMT measurement by ultrasonographic scanning were done for each patient. All these findings were assessed using appropriate statistical methods. RESULTS The study revealed that even in the absence of smoking and alcohol, normotension and normal lipid profile, an increase in the duration of diabetes, altered fasting and postprandial glycaemic status can lead to CIMT>0.9 which is a marker of increased risk for atherosclerosis. CONCLUSION CIMT greater than 0.9 mm is an individual marker of generalised atherosclerosis. Patients with these values are at higher risk for future cardiovascular events and newer or recurrent ischaemic strokes. Measuring CIMT values in all diabetics can predict the risk of developing atherosclerosis related adverse events and better control of diabetes mellitus can aid in achieving regression of CIMT.
Archives of Endocrinology and Metabolism, 2017
Objective: This study aimed to evaluate the occurrence and clinical predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM. Subjects and methods: The study included 45 women with type 1 diabetes mellitus (DM) (aged 36 ± 9 years) who underwent carotid Doppler ultrasound evaluation to determine the carotid artery intima-media thickness (CIMT) and to assess the occurrence of carotid artery plaques. Insulin sensitivity was assessed by estimated glucose disposal rate (eGDR), and metabolic syndrome (MS) was defined by the World Health Organization criteria. Results: The cohort had a mean age of 36 ± 9 years, diabetes duration of 18.1 ± 9.5 years, and body mass index (BMI) of 24.6 ± 2.4 kg/m 2. MS was present in 44.4% of the participants. The CIMT was 0.25 ± 0.28 mm, and the prevalence of carotid artery plaques was 13%. CIMT correlated positively with hypertension (p = 0.04) and waist-to-hip ratio (r = 0.37, p = 0.012). The presence of carotid artery plaques correlated positively with age (p = 0.018) and hypertension (p = 0.017). eGDR correlated negatively with CIMT (r =-0.39, p = 0.009) and carotid plaques (p = 0.04). Albuminuria showed a correlation trend with CIMT (p = 0.06). Patients with carotid artery plaques were older, had a higher prevalence of hypertension, and lower eGDR. No correlation was found between CIMT and carotid plaques with diabetes duration, MS, BMI, cholesterol profile, glycated hemoglobin, high-sensitivity C-reactive protein, or fibrinogen. Conclusion: Insulin resistance, central obesity, hypertension, and older age were predictors of subclinical atherosclerosis in asymptomatic, young adult women with type 1 DM.
Diabetes Care, 1999
OBJECTIVE: There is substantial evidence that glucose intolerance is associated with an increased risk of cardiovascular disease. However, it is not well established whether plasma glucose is independently related to atherosclerosis when glucose tolerance is normal and, if so, to which stage of the complex atherosclerotic process. RESEARCH DESIGN AND METHODS: We prospectively examined the status of carotid arteries in 625 subjects aged 40-79 years who were randomly selected from the general population and had normal glucose tolerance (according to World Health Organization criteria) both at baseline and at 5 years of follow-up. All subjects had high-resolution echo-duplex evaluation of the common and internal carotid arteries (eight regions of interest on both sides) in 1990 and 1995 to detect the change in carotid status over time. The occurrence of new plaques in previously normal segments was termed "incident nonstenotic" or "early atherosclerosis," and the oc...
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Patients with Type 2 Diabetes Mellitus (DM) suffer from premature severe atherosclerosis and can have multivascular involvement. Aims and Objectives-To determine the prevalence of Carotid Atherosclerosis (CA) and Peripheral Vascular Disease (PVD) in Type 2 DM patients with coronary artery disease. To correlate multivascular morbidity with risk factors. MATERIALS AND METHODS In cross-sectional hospital-based study, 120 consecutive patients of Type 2 DM with CAD underwent Doppler studies and prevalence of CA or PVD was determined as per IMT, plaques and luminal stenosis. Macrovascular multimorbidity defined as presence of CA or PVD or both along with CAD. They were assessed for risk factors. Patients were divided into 2 groups: Group I-CAD alone, Group II-Multivascular morbidity. Comparisons were made using student 't' test and chi-square for univariate analysis and multivariate analysis done finally. RESULTS Mean age of patients was 56.17 + 7.8 years with M:F = 1:1. Of 120 patients 71 (59.1%) had CA (p=0.001), 40 (33.3%) had PVD (p=0.732) and 28 (23.3%) had both CA and PVD. Of 71 with CA 37 (52.11%) had increased IMT, 34 (47.88%) had plaques/luminal stenosis. Of 40 with PVD, 33 (82.5%) had increased IMT, 7 (17.5%) had plaques/stenosis. On univariate analysis male sex, age, duration of diabetes, hypertension, elevated fasting blood glucose and HbA1c, high LDL and low LDL were significantly associated with multivascular involvement. On multivariate analysis age, duration of diabetes, HbA1c were independent risk factors for multivascular involvement. CONCLUSION There is significantly high prevalence of macrovascular multimorbidity in Type 2 DM patients with CAD, more commonly in males. It is more with increasing age, Diabetes duration, Hypertension, uncontrolled DM and dyslipidaemia.
Carotid atherosclerosis progression and cerebrovascular events in patients with diabetes
Journal of Diabetes and its Complications, 2016
Aim: Carotid atherosclerosis progression is associated with a higher risk of cerebrovascular events but there is no specific data for diabetes. We assessed in a cohort of patients with diabetes the rate of atherosclerosis progression by doppler ultrasonography and the association with cerebrovascular events. Methods: We analyzed a retrospective cohort of 342 patients with a mean duration of diabetes of 13.6 ± 10.6 years. The mean delay between the first and last doppler ultrasonography was 6.4 ± 4.6 years, with a mean of 3.4 examinations per person. Cerebrovascular events were noted. Results: A progression of carotid atherosclerosis was observed in 20.1% of cases. No factor was significantly associated with progression. A prophylactic carotid endarterectomy was performed on 6 of the 27 patients with a stenosis ≥ 50%. A cerebrovascular event occurred in 1.2% of patients; none of them had carotid atherosclerosis progression. Conclusions: Carotid atherosclerosis progression in patients with diabetes is frequent but surgical treatment and cerebrovascular events are low. The benefit of a systematic follow-up of carotid atherosclerosis seems limited.
Archives of Endocrinology and Metabolism, 2017
Objectives: Cardiovascular risk estimated by several scores in patients with diabetes mellitus without a cardiovascular disease history and the association with carotid atherosclerotic plaque (CAP) were the aims of this study. Materials and methods: Cardiovascular risk was calculate using United Kingdom Prospective Diabetes Study (UKPDS) risk engine, Framingham risk score for cardiovascular (FSCV) and coronary disease (FSCD), and the new score (NS) proposed by the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol. Ultrasound was used to assess CAP occurrence. A receiver operating characteristic (ROC) analysis was performed. Results: One hundred seventy patients (mean age 61.4 ± 11 years, 58.8% men) were included. Average FSCV, FSCD and NS values were 33.6% ± 21%, 20.6% ± 12% and 24.8% ± 18%, respectively. According to the UKPDS score, average risk of coronary disease and stroke were 22.1% ± 16% and 14.3% ± 19% respectively. Comparing the risks estimated by the different scores a significant correlation was found. The prevalence of CAP was 51%, in patients with the higher scores this prevalence was increased. ROC analysis showed a good discrimination power between subjects with or without CAP. Conclusion: The cardiovascular risk estimated was high but heterogenic. The prevalence of CAP increased according to the strata of risk. Understanding the relationship between CAP and scores could improve the risk estimation in subjects with diabetes.
Polish Archives of Internal Medicine, 2017
IntroductIon The estimated number of peo ple with diabetes worldwide is 387 million, and it will reach 592 million by the year 2035. 1 Diabe tes is a considerable public health problem. It can cause devastating long term microvascular and macrovascular complications, which mainly affect the kidney, eyes, heart, and arteries. 2 Traditional ly, the microvascular and macrovascular compli cations of type 2 diabetes have been viewed sepa rately; however, there is a strong indication from clinical studies that they may share a common