Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study (original) (raw)
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Diabetes care, 2018
Cardiovascular disease (CVD) risk prediction represents an increasing clinical challenge in the treatment of diabetes. We used a panel of vascular imaging, functional assessments, and biomarkers reflecting different disease mechanisms to identify clinically useful markers of risk for cardiovascular (CV) events in subjects with type 2 diabetes (T2D) with or without manifest CVD. The study cohort consisted of 936 subjects with T2D recruited at four European centers. Carotid intima-media thickness and plaque area, ankle-brachial pressure index, arterial stiffness, endothelial function, and circulating biomarkers were analyzed at baseline, and CV events were monitored during a 3-year follow-up period. The CV event rate in subjects with T2D was higher in those with ( = 440) than in those without ( = 496) manifest CVD at baseline (5.53 vs. 2.15/100 life-years, < 0.0001). New CV events in subjects with T2D with manifest CVD were associated with higher baseline levels of inflammatory bio...
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.
Journal of Cardiovascular Development and Disease, 2021
The aim of this study was to assess the factors associated with impaired vascular function in patients with poorly controlled type 2 diabetes (DM2) with and without overt cardiovascular disease (CVD). Ninety-five patients with DM2 and poor glycemic control were recruited and divided into two groups: Group 1, with known CVD (n = 38), and Group 2, without CVD (n = 57). Patients in Group 2 were further subdivided into those with short (<5 years, group 2b) and long (>5 years, group 2a) diabetes duration. Subclinical markers of atherosclerosis were assessed. Glycemic control was similar in the two groups (HbA1c: 9.2% (1.5) vs. 9.4% (1.8), p = 0.44). In Group 1, lower FMD (3.13 (2.16)% vs. 4.7 (3.4)%, p < 0.05) and higher cIMT (1.09 (0.3) mm vs. 0.96 (0.2) mm, p < 0.05) was seen compared with Group 2, whereas PWV was similar (12.1 (3.4) vs. 11.3 (3.0) m/s, p = 0.10). Patients in Group 2b had significantly lower PWV and cIMT and higher FMD compared to Group 1 (p < 0.05). Amo...
Impact of hypertension on various markers of subclinical atherosclerosis in early type 2 diabetes
Journal of Diabetes & Metabolic Disorders, 2014
Background: Presence of Diabetes Mellitus increases the risk of subclinical atherosclerosis. In this study was aimed to determine the influence of hypertension (HTN) on surrogate markers of atherosclerosis in a population of patients with early type 2 diabetes. Methods: 125 diabetic subjects drawn from Dr. Shariati outpatient's clinic list and 153 non-diabetic subjects who were the relatives in law of diabetic participants were recruited. Participants with type 2 diabetes were free of clinical evidence of cardiovascular disease and renal involvement. Two groups of diabetic and control were further divided into two subgroups of hypertensive (known case of HTN or blood pressure ≥140/90 mmHg) and normotensive, and anthropometric characteristics, metabolic biomarkers as well as markers of subclinical atherosclerosis including Carotid intima media thickness (CIMT), flow mediated dilation (FMD) and Ankle Brachial Index (ABI) were measured. Results: Diabetic group with a mean age of 49.9 ± 7.5 years had significantly higher CIMT (0.64 ± 0.14 vs 0.76 ± 0.19, p = 0.001) and lower FMD (16.5 ± 8.1 vs 13.3 ± 7.1, p = 0.003) and ABI (1.2 ± 0.1 vs 1.1 ± 0.1, p = 0.01) than control with mean age of 52.9 ± 10.1 years. 34% of control and 59.2% of diabetic were hypertensive. Fasting blood sugar, insulin levels and calculated insulin resistance index of HOMA IR. of hypertensive subjects were higher than normotensive subjects in both groups of diabetic and non-diabetic. Similar pattern was presented for measured inflammatory mediators of hs-CRP and IL-6. Among subclinical atherosclerosis markers, only CIMT was significantly different between hypertensive and normotensive subjects in both groups. In adjusted linear regression analysis, a constant significant association existed between age and CIMT, ABI and FMD in non-diabetic, while in diabetic, age only correlated with CIMT and not the other two markers. In multiple regression model, HTN was recognized as a risk factor for increasing CIMT (OR = 2.93, 95% CI = 1.03-8.33, p = 0.04) but not attenuating FMD or ABI.
Determinants of vascular function in patients with type 2 diabetes
Cardiovascular Diabetology, 2012
Type 2 diabetes mellitus (T2DM) is independently associated with an increased risk for cardiovascular diseases that is primarily due to the early development of advanced atherosclerotic vascular changes. The aim of our study was to investigate the predictors of vascular dysfunction in T2DM patients.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2014
Background: Increased arterial stiffness may be an important pathway linking diabetes mellitus to increased cardiovascular risk. Aim: The study was conducted to assess the surrogate markers of arterial stiffness in patients with Type 2 diabetes mellitus (T2DM), and compare with age-matched hypertensive and healthy controls. Also the effect of age and blood pressure on these markers was evaluated. Settings and Design: This cross-sectional study was carried out at a tertiary care hospital in West India. Methods: After a detailed medical history and anthropometric evaluation, all the participants were subjected to measurements of Arterial Stiffness Index (ASI), Pulse Wave Velocity (PWV), and Augmentation Index (AIx) using a non-invasive oscillometric method. The four study groups consisted of patients with T2DM (>5 years) along with hypertension, newly diagnosed patients with T2DM (<2years) without hypertension, hypertensive controls, and healthy controls. Results: PWV, ASI, AIx were elevated in patients with T2DM compared to healthy controls (p<0.05). Patients with T2DM above 60 years had higher carotid-femoral PWV, ASI and AIx than those below 60 years (p<0.05). ASI and AIx were significantly increased in patients with T2DM with hypertension having systolic BP > 140 mmHg compared to those with systolic BP < 140 mmHg. A very strong correlation between PWV and AIx in patients with T2DM and hypertensive controls was observed. Conclusion: This study reveals that markers of arterial stiffness (PWV, ASI, AIx) were increased significantly in patients with T2DM compared to healthy controls. Age and systolic blood pressure had significant influence on these markers. Thus, oscillometric markers have potential utility in identifying subclinical atherosclerosis in patients with T2DM.
Diabetes, Obesity and Metabolism, 2004
Endothelial dysfunction, oxidative stress and systemic inflammation play an important role in the enhanced cardiovascular risk in diabetes. Carotid intima-media thickness (IMT), a widely accepted marker of subclinical atherosclerosis, is known to be increased in patients with type 2 diabetes. The relationships between plasma markers of cardiac risk and carotid IMT are not well known. We therefore studied a group of patients with type 2 diabetes to evaluate the relationships between plasma markers of cardiac risk and carotid IMT. We measured carotid IMT and the levels of soluble endothelial adhesion molecules [sE-selectin, intercellular cell adhesion molecule-1 (sICAM-1) and vascular cell adhesion molecule-1 (sVCAM-1)], C-reactive protein (CRP) and 8-isoprostane in 40 patients with type 2 diabetes without clinical macrovascular complications (HbA1c<10%, duration of diabetes<12 years) and 25 healthy subjects. We then examined the correlations between these plasma markers, carotid IMT and various clinical and biochemical parameters. Diabetic patients had higher plasma sE-selectin (p=0.03), sICAM-1 (p=0.05), CRP (p=0.047) and 8-isoprostane (p=0.001) concentrations than control subjects. Mean IMT values were identical (0.63 +/- 0.02 mm) in diabetic (range, 0.40-0.92 mm) and healthy subjects (range, 0.45-0.85 mm). In diabetic patients, stepwise multivariate analysis showed that HbA1c and plasma glucose were independent predictors of sE-selectin (r2=0.19 and r2=0.17, p<0.01, respectively), whereas waist circumference and body mass index (BMI) were predictors of sICAM-1 (r2=0.27, p=0.001 and r2=0.22, p=0.002, respectively). Waist circumference was the only predictor of CRP (r2=0.2, p<0.01), and systolic blood pressure was the only predictor of 8-isoprostane (r2=0.19, p=0.006). In control subjects, similar analysis showed that plasma glucose and waist circumference were predictors of sE-selectin and sICAM-1, respectively (r2=0.2, p<0.05). These results indicate that some well-controlled type 2 diabetic patients free of clinical macrovascular complications have elevated plasma markers of cardiovascular risk without having increased IMT. The elevation of plasma markers of endothelial cell activation (sE-selectin and s-ICAM-1) or inflammation (CRP) and oxidative stress (8-isoprostane) in diabetics vs. controls is distinct from and cannot be explained simply by differences in the burden of atherosclerosis as assessed by carotid IMT.
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
Background: Diabetes mellitus is becoming one of the major health problems in developing countries. The number of adults living with type 2 diabetes mellitus (T2DM) worldwide is increasing over time. Cardiovascular disease (CVD) is the major cause of death in T2DM. The objective of this study was to determine the prevalence of cardiovascular disease and its associated factors among diabetic patients at the MRC clinic of Dilla University Referral Hospital (DURH). Methods: A hospital-based cross-sectional study was conducted from April to May 2019. A total of 216 diabetic individuals were selected with a convenient sampling technique from patients on follow-up at DURH MRC. Data were collected using a structured format. The diagnosis of CVD was made with the necessary diagnostic tests and examination. The data analysis was done in SPSS software version 20. Bivariate and multivariable logistic regression analysis was carried out to identify factors associated with cardiovascular disease. Results: A total of 216 patients participated in the study and the mean age of the study participants was 30 years; 83.3% of the study participants were male. The overall prevalence of cardiovascular disease was 25% of which 57% were ischemic heart disease, 32% were hypertensive and 10% were stroke. Duration of DM for more than 10 years and diabetic drug discontinuation were factors associated with cardiovascular disease. Odds of CVD was nearly four times more in those whose duration of DM is more than 10 years (AOR=4.00, 95% CI: 2.386-6.705) and odds of CVD among those who discontinued medication were almost three times more, (AOR=2.98, 95% CI: 1.287-6.080). Conclusion: A quarter of the diabetic population studied developed CVD. Duration of DM for more than 10 years and drug discontinuation are independent associated factors of CVD. Hence appropriate intervention at early stages should be implemented at primary healthcare level.
Vascular responsiveness in type 2 diabetes mellitus (T2DM)
QJM, 2016
Background: Diabetic retinopathy is used for staging of progression of micro and macro-vascular complications of patients with DM. Our hypothesis was that diabetic patients at different stages of retinopathy would have different vascular responsiveness that will be used as a surrogate marker of macro-vascular disease for risk assessment of cardiovascular complications. Methods: A prospective study enrolled 96 patients. Twenty-three healthy volunteers (44 6 11 years), 25 diabetic patients without retinopathy (63 6 11 years), 25 patients with non-proliferative retinopathy [NPDR] (62 6 9 years) and 23 patients with proliferative diabetic retinopathy [PDR] (59 6 10 years). All patients underwent an ophthalmologic examination to diagnose retinopathy staging, and vascular responsiveness evaluation that included endothelial function evaluation (using the brachial artery method to measure flow mediated diameter change (FMD%)) and measuring the ankle-brachial blood pressure ratio, a measure of arterial stiffness. Results: Endothelial function was severely impaired in all diabetic patients. Patients with PDR had an FMD% of À3.1 6 6.6%, patients with NPDR had À3.3 6 9.2%, patients without retinopathy À1.9 6 7.4% (P ¼ NS between all groups of patients). Healthy controls had an FMD% of 16.5 6 7.5% with a significant difference (P < 0.001) compared with each group of patients. No difference in FMD% was observed among patients (P ¼ 0.93 between PDR and NPDR groups, P ¼ 0.54 between NPDR and no retinopathy groups and P ¼ 0.71 between patients without retinopathy and those with PDR). The ankle brachial (ABI) ratio was 1.03 6 0.28 in the PDR group, 1.14 6 0.24 in the NPDR group and 0.97 6 0.18 in the noretinopathy group. Healthy volunteers had an ABI of 1.07 6 0.18. No difference was observed between ABI of PDR and NPDR patients (P ¼ 0.17) and between patients without retinopathy and PDR patients (P ¼ 0.91). However, a significant difference was observed between the NPDR and no-retinopathy groups (P ¼ 0.008). No significant difference was found between ABI ratios when compared with the control group (P ¼ 0.62 for PDR, P ¼ 0.26 for NPDR and P ¼ 0.07 for the no-retinopathy group). No difference was observed in age and BMI among all groups of patients (P ¼ NS for all). Patients were older (P < 0.001) and had a higher BMI (P < 0.001). Interestingly there was no difference in height among groups of patients, but controls were significantly taller compared with each group of patients (P < 0.02). Conclusions: All patients with T2DM had severe endothelial dysfunction with no difference among the different retinopathy groups. In our patients, all patients had a normal arterial stiffness but patients without retinopathy who had the highest arterial stiffness. We could not distinguish vascular traits that would define diabetic patients at the highest risk to develop cardiovascular complications.
Background: Atherosclerosis which is a precursor for macro-vascular disease involves both functional as well as structural changes in the vasculature. Functional changes involve abnormalities in endothelium, vascular smooth muscle cells and platelet functions. Endothelial dysfunction was reported in type 2 DM cases. Ultrasound assessment of brachial artery FMD (Flow Mediated Dilatation) provides important information about vascular function in health and disease. Low FMD values predict independently an established atherosclerosis. Materials and methods: A total of 150 individuals included in this study; 100 were diabetes mellitus patients and 50 were age matched persons without diabetes, hypertension or vascular disease. Of 100 diabetes patients 50 each were grouped in two groups with good (HbA1c <7.5%) and poor (HbA1C >7.5%) control of hyperglycemia. Brachial artery flow mediated vasodilatation (FMD) was studied in all patient after overnight fasting (8 hours) using 7.5 MHz phased array transducer. The medial epicondyle was used as anatomical landmark for brachial artery. Observations: In this study it is observed that, the mean age for FMD <4.5% is 59.70±11.08 and FMD >4.5% is 56.53±8.37. Age is higher in diabetics with FMD % <4.5. Females who FMD <4.5% were 50.0% and 42.5% with FMD >4.5%. Smoking in diabetics with FMD <4.5% was 10.0% and FMD >4.5 % was 15%. Hypertension was equally found 40%. Family history of diabetes with FMD % <4.5 was 30% and FMD >4.5% were none. Summary and conclusions: The data suggest that endothelial function is a useful prognostic marker in coronary artery disease patients. In these patients, it has been reported that endothelial dysfunction is an independent prognostic factor and may predict future events, irrespective of the angiographic severity of the disease. Moreover, blunted endothelial function may reflect early atherosclerosis, and should lead to a detailed evaluation.