DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20175737

Carotid artery intima media thickness in relation with atherosclerotic risk factors in patients with newly diagnosed type 2 diabetes mellitus in a rural tertiary care hospital in central India

Vijay Kumar Verma

Abstract


Background: Vascular complications of atherosclerosis are major causes of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). The aim of the study was to study the correlation between carotid artery intima media thickness (CIMT) and risk factors for atherosclerosis and atherosclerotic vascular events in newly diagnosed type 2 diabetes mellitus patients with an objective to determine the predictive value of CIMT as an indicator of early atherosclerosis.

Methods: The predictive value of CIMT as well as various atherosclerotic risk factors including ankle brachial index (ABI) were determined as an indicator of early atherosclerosis. Data were presented in form of percentage and proportions. Qualitative variables were tested using Chi square test and the p values were calculated between the groups having CIMT less than and more than 0.9 mm. p values of ≤0.05 were considered statistically significant. Averages were expressed between groups as mean ±standard deviation or as percentage. Multivariate analysis was done using the multiple linear regression model.

Results: The study showed that though age, smoking and dyslipidemia did not show any association with CIMT; hypertension, ABI, glycosylated hemoglobin and urine albumin excretion rate had positive correlation with CIMT with statistically significant association between ABI and CIMT.

Conclusions: Assessment of CIMT by B mode ultrasound is a relatively inexpensive means of measuring subclinical atherosclerosis. Present study showed that CIMT is significantly higher in those type 2 diabetic patients who had atherosclerotic events than in those type 2 diabetic patients who had only risk factors for atherosclerosis.


Keywords


Atherosclerosis, Ankle brachial index, Carotid intima media thickness, Diabetes mellitus

Full Text:

PDF

References


Agarwal AK, Singla S, Singla S, Singla R, Lal A, Wardhan H, Yadav R. Prevalence of coronary risk factors in type 2 diabetics without manifestations of overt coronary heart disease. J Assoc Physicians Ind. 2009;57:135-42.

McGarry PA, McMohan CA, Montenegro MR. General findings of the International Atherosclerosis Project. Lab Invest. 1968;18:498-502.

Frouse JR. An evaluation of methods for imaging and quantifying coronary and carotid lumen stenosis and Atherosclerosis. Circulation. 1993;87:1117-33.

Smith SC, Greenland P, Grundy SM. AHA Conference Proceedings Prevention conference v Beyond Secondary/prevention: Identifying the high-risk patient for primary prevention. Executive summary. Circulation. 2000;101:111-116.

Greenland P, Abrams J, Aurigemma FP, Bond MG, Clark LT, Criqui MH et al. Prevention Conference V: Beyond secondary prevention identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden; Writing Group III. Circulation. 2000;101:E16-22.

Mohan V, Ravikumar R, Shanthi Rani, Sand Deepa R. Intimal medial thickness of the carotid artery in south Indian diabetic and non-diabetic subjects: The Chennai Urban Population Study (CUPS). Diabetologia. 2000;43:494-99.

Kraml, Potockova J, Andel M, Zvarova J, Stefek M. Sonographic measurement of intimal thickness of the common carotid artery in diabetics. Vnitr Lek. 1999;45:457-62.

Mykkänen L, Zaccaro DJ, O’Leary DH, Howard G, Robbins DC, Haffner SM. Microalbuminuria and carotid artery intima-media thickness in nondiabetic and NIDDM subjects. Stroke. 1997;28(9):1710-6.

Frouse JR. An evaluation of methods for imaging and quantifying coronary and carotid lumen stenosis and Atherosclerosis. Circulation. 1993;87:1117-33.

Kotsis VT, Stabouli SV, Papamichael CM, Zakopoulos NA. Impact of obesity in intima media thickness of carotid arteries. Obesity. 2006;14(10):1708-15.

Geroulakos G, Ramaswami G, Veller MG, Fisher GM, Renton S, Nicolaides A, Waldron HA, Diamond J, Elkeles RS. Arterial wall changes in type 2 diabetic subjects. Diabetic medicine. 1994;11(7):692-5.

Temelkova-Kurktschiev TS, Koehler C, Leonhardt W, Schaper F, Henkel E, Siegert G, et al. Increased intimal-medial thickness in newly detected type 2 diabetes: risk factors. Diabetes care. 1999;22(2):333-8.

Burke GL, Evans GW, Riley WA, Sharrett AR, Howard G, Barnes RW, et al. Arterial wall thickness is associated with prevalent cardiovascular disease in middle-aged adults. Stroke. 1995;26(3):386-91.

Guvener N, Tutuncu NB, Oto A, Erbas T. Major determinants of the carotid intima-media thickness in type 2 diabetic patients: age and body mass index. Endocr J. 2000;47:525-33.

Bonora E, Tessari R, Miccolo R, Zenera M, Targer G, Padovani R, et al. Intima-media thickness of the carotid artery in nondiabetic and NIDDM patients. Relationship with insulin resistance. Diabetes Care. 1997;20:66-73.

Sahoo R, Krishna MV, Subrahmaniyan DKS, Dutta TK, Elangovan S. Common carotid intima-media thickness in acute ischemic stroke: A case control study. Neurol Ind. 2009;57:627-30.

Kreutzenberg SV, Tiengo A, Avogaro A. Cerebrovascular disease in diabetes mellitus: the role of carotid intima-media thickness. Nutr Metab Cardiovasc Dis. 2009;19:667-73.

Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation. 2007;115:459-67.

Wagenknecht LE, Zaccaro D, Espeland MA, Karter AJ, O’Leary DH, Haffner SM. Diabetes and progression of carotid atherosclerosis. Arteriosclerosis, Thrombosis, Vascular Bio. 2003;23(6):1035-41.

Jadhav UM, Kadam NN. Carotid intima-media thickness as an independent predictor of coronary artery disease. Ind Heart J. 2001;53:458-62.

Gæde P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Eng J Medic. 2003;348(5):383-93.

Maple-Brown L, Cunningham J, Celermajer DS, O’Dea K. Increased carotid intima-media thickness in remote and urban Indigenous Australians: impact of diabetes and components of the metabolic syndrome. Clin Endocrinol (Oxf). 2007;66:419-25.

Lo J, Dolan SE, Kanter JR, Hempill LC, Conelly JM, Lees RS, et al. Effects of Obesity, Body Composition, and Adiponectin on Carotid Intima-Media Thickness in Healthy Women. J Clin Endo Met. 2006;91:1677-82.

Guvener N, Tutuncu NB, Oto A, Erbas T. Major determinants of the carotid intima-media thickness in type 2 diabetic patients: age and body mass index. Endocr J. 2000;47:525-33.

Bonora E, Tessari R, Miccolo R, Zenera M, Targer G, Padovani R, et al. Intima-media thickness of the carotid artery in nondiabetic and NIDDM patients. Relationship with insulin resistance. Diabetes Care. 1997;20:66-730.