Determinants of early carotid atherosclerosis progression in young patients with type 1 diabetes mellitus

Summary

The results of cross-sectional studies addressing early preintrusive atherosclerosis in type 1 diabetic patients are conflicting. In an observational longitudinal study we determined the course of carotid artery intima-media thickness (IMT) over a period of 2.5 years in mean. A total of 102 patients with type 1 diabetes mellitus (age ≤ 40 years, diabetes duration ≥ 2 years at baseline examination) who were participants of the baseline examination was studied again in a follow-up. HbA1c, albumin excretion rate (AER), lipids, systolic and diastolic blood pressure, retinopathy, and current smoking status were assessed at baseline and follow-up. The IMT of the common carotid artery was measured by high-resolution ultrasound, the maximum IMT was evaluated. The annual progression rate (APR) was calculated from the difference between baseline and follow-up IMT reading and the time between both examinations. The follow-up IMT was significantly higher, compared to the baseline measurement: 0.65 ± 0.18 vs. 0.57 ± 0.14 mm (p < 0.001), the mean APR was 0.033 mm/year. The APR was correlated with age (r = 0.337, p < 0.01), diabetes duration (r = 0.252, p < 0.05), hypertension (r = 0.225, p < 0.05), and systolic blood pressure (r = 0.281, p < 0.05) at the baseline examination. Comparing subgroups, defined according to APR tertiles, with no IMT progression (first tertile, mean APR - 0.012 mm/year), mild progression (second tertile, mean APR 0.037 mm/year), and advanced progression (third tertile, mean APR 0.088 mm/year), patients with advanced progression significantly (p < 0.05) more often had hypertension and nephropathy than subjects with mild progression. In a multiple linear regression analysis, the changes of plaque frequency and of the nephropathy status between baseline and follow-up examinations were independent predictors of the APR.

Keywords:

Diabetes mellitus type 1 - Early atherosclerosis - Intima-media thickness - Carotid arteries - Nephropathy

References

• 1 Belcaro G, Laurora G, Cesarone M R, De Sanctis M T, Incandela L, Barsotti A. Progression of subclinical atherosclerosis in 6 years. Ultrasound evaluation of the average, combined femoral and carotid bifurcation intima-media thickness.  VASA. 1995;  24 227-232
• 2 Frost D, Beischer W. Determinants of carotid artery wall thickening in young patients with type 1 diabetes mellitus.  Diabetic Med. 1998;  15 851-857
• 3 Frost D, Pfohl M, Clemens P, Häring H J, Beischer W. Evaluation of the insertion/deletion ACE gene polymorphism as a risk factor for carotid artery intima-media thickening and hypertension in young type 1 diabetic patients.  Diabet Care. 1998;  21 836-840
• 4 Grobbee D E, Bots M L. Carotid artery intima-media thickness as an indicator of generalized atherosclerosis.  J Intern Med. 1994;  236 567-573
• 5 Heiss G, Sharrett A R, Barnes R, Chambless L E, Szklo M, Alzola C. and the ARIC investigators . Carotid atherosclerosis measured by B mode ultrasound in populations: Associations with cardiovascular risk factors in the ARIC study.  Am J Epidemiol. 1991;  134 250-256
• 6 Hodis H N, Mack W J, LaBree L, Selzer R H, Liu C R, Liu C H, Azen S P. The role of carotid arterial intima-media thickness in predicting clinical coronary events.  Ann Intern Med. 1998;  128 262-269
• 7 Howard G, Burke G L, Szklo M, Tell G S, Eckfeldt J, Evans G, Heiss G. Active and passive smoking are associated with increased carotid wall thickness. The Atherosclerosis Risk in Communities Study.  Arch Intern Med. 1994;  154 1277-1282
• 8 MacMahon S, Sharpe N, Gamble G, Hart H, Scott J, Simes J, White H. Effects of lowering average or below-average cholesterol levels on the progression of carotid atherosclerosis.  Circulation. 1998;  97 1784-1790
• 9 Mogensen C E, Christensen K, Vittinghus E. The stages in diabetic renal disease. With emphasis on the stage of incipient diabetic nephropathy.  Diabetes. 32 ((Suppl 2)) 1983;  64-78
• 10 Poli A, Tremoli E, Colombo A, Sirtori M, Pignoli P, Paoletti R. Ultrasonographic measurement of the common carotid artery wall thickness in hypercholesterolemic patients.  Atherosclerosis. 1988;  70 253-261
• 11 Salonen J T, Salonen R. Ultrasound B-Mode imaging in observational studies of atherosclerotic progression.  Circulation. 87 ((Suppl 2)) 1993;  II-56-II-65
• 12 Salonen J T, Nyyssönen K, Salonen R, Porkkala-Sarataho E, Tuomainen T P, Diezfalusy U, Björkhem I. Lipoprotein oxidation and progression of carotid atherosclerosis.  Circulation. 1997;  95 840-845
• 13 Wendelhag I, Wiklund O, Wikstrand J. Arterial wall thickness in familial hypercholesterolaemia. Ultrasound measurement of intima-media thickness in the common carotid artery.  Arterioscler Thromb. 1992;  12 70-77
• 14 Yamasaki Y, Kodama M, Nishizawa H, Sakamoto K, Matsuhisa M, Kajimoto Y, Kosugi K, Shimizu Y, Kawamori R, Hori M. Carotid intima-media thickness in Japanese type 2 diabetic subjects.  Diabetes Care. 2000;  23 1310-1315