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.
2. Manson JE, Colditz GA, Stampfer MJ, Willett WC, Krolewski AS, Rosner B, et al. A prospective study of maturity-onset diabetes and risk of coronary heart disease and stroke in women. Arch Intern Med. 1991;151:1141-1147.
3. Haffner SM, Stern MP, Hazuda HP, Mitchell BD, Patterson JK. Cardiovascular risk factors in confirmed prediabetic individuals: Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? Journal of the American Medical Association. 1990;263:2893-2898.
4. Bond MG, Barnes RW, Riley WA, Wilmoth SK, Chambless LE, Howard G. et al. High‐resolution B‐Mode Ultrasound Scanning Methods in the Atherosclerosis Risk in Communities Study (ARIC). Journal of Neuroimaging. 1991;1:68-73.
5. Pignoli P, Tremoli E, Pli A, Oreste P, Paoletti R. A direct measurement of intima plus medial thickness of the arterial wall by ultrasound imaging. Circulation. 1986;74(6):1399-1406.
6. Pignoli P. Ultrasonography B mode imaging for arterial wall thickness measurement. Atherosclerosis Review. 1984;12:177-189.
7. Temelkova-Kurktschiev T, Koehler C, Leonhardt W, Schper F, Henkel E, Siegert G, et al. Increased intimal-medial thickness in newly detected type 2 diabetes. Diabetes Care. 1999; 22:333-338.
8. Mitsuhashi N, Onuma T, Kubo S, Takayanagi N, Honda M, Kawamori R. Coronary artery disease and carotid artery intima-media thickness in Japanese type 2 diabetic patients. Diabetes Care. 2002;25:1308-1312.
9. Yokoyama H, Katakami N, Yamasaki Y. Recent advances of intervention to inhibit progression of carotid intima-media thickness in patients with type 2 diabetes mellitus. Stroke. 2006;37:2420-2427.
10. Polak JF, Backlund J-YC, Cleary PA, Harrington AP, O’Leary DH, Lachin JM, et al. Progression of carotid artery intima-media thickness during 12 years in the diabetes control and complications trial/epidemiology of diabetes interventions and complications (DCCT/EDIC) study. Diabetes. 2011;60:607-613.
11. Kota SK, Mahapatra GB, Kota SK, Naveed S, Tripathy PR, Jammula S, et al. Carotid intima media thickness in type 2 diabetes mellitus with ischemic stroke. Indian J Endocrinology and Metabolism. 2013;17(4):716-722.
12. Lorenz MW, Price JF, Robertson C, Bots ML, Polak JF, Poppert H, et al. Carotid intima-media thickness progression and risk of vascular events in people with diabetes: Results from the PROG-IMT collaboration. Diabetes Care. 2015;38:1921-1929.
13. Jadhav UM, Kadam NN. Association of microalbuminuria with carotid intima-media thickness and coronary artery disease – A cross-sectional study in western India. Journal of the Association of Physicians of India. 2002;50:1142-1149.
14. Ishizaka N, Ishizaka Y, Toda E-I, Nagai R, Yamakado M. Association between serum uric acid, metabolic syndrome, and carotid atherosclerosis in Japanses individuals. Arterioscler Thromb Vasc Biol. 2005;25:1038-1044.
15. Wagenknecht LE, D'Agostino RB Jr, Haffner SM, Savage PJ, Rewers M. Impaired glucose tolerance, type 2 diabetes, and carotid wall thickness: the Insulin Resistance Atherosclerosis Study. Diabetes Care. 1998;21(11):1812-1818.
16. Kawamori R, Yamasaki Y, Matsushima H, Nishizawa H, Nao K, Hougaku H, et al. Prevalence of carotid atherosclerosis in diabetic patients: ultrasound high resolution B mode imaging on carotid arteries. Diabetes Care. 1992;15:1290-1294.
17. Kotsis VT, Stabouli SV, Papamichael CM, Zakopoulos NA. Impact of obesity in intima media thickness of carotid arteries. Obesity. 2006;14(10):1708-1715.
18. Al-Nimer MS, Hussein II. Increased mean carotid intima media thickness in type 2 diabetes mellitus patients with non-blood pressure component metabolic syndrome: A preliminary report. Int J Diabetes Dev Ctries. 2009;29(1):19-22.
19. O’Rouke RA, Brundage BH, Froelicher VF, Greenland P, Grundy SM, Hachamovitch R, et al. American College of Cardiology/American Heart Association Expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation. 2000;102:126-140.
20. WHO (1995). Physical status: The use of interpretation of anthropometry. Report of a WHO Expert Committee, WHO Technical Report Series 854, Geneva, Switzerland.
21. Mitsuhashi N, Takayanagi N. Coronary artery disease and carotid artery intima-media thickness in Japanese type 2 diabetic patients. Diabetes Care. 2002;25(8):1308-1312.
22. Gao L, Bai L, Shi M, Ni J, Lu H, Wu Y, et al. Association between carotid intima-media thickness and fasting blood glucose level: A population-based cross-sectional study among low-income adults in rural China. J Diabetes Investig. 2017;8(6):788-797.
Copyright (c) 2019 Malay Acharyya, Swapan Kumar Haldar
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.