Carotid intima-media thickness and arterial stiffness in type 1 diabetic patients with and without microangiopathy

Abstract

A b s t r a c tIntroduction: The aim of the study was to assess carotid intima-media thickness (CIMT) as a subclinical marker of atherosclerosis and arterial stiffness in type 1 diabetic patients in relation to microangiopathy. Material and methods: We included 87 type 1 diabetic patients (44 women, 43 men), median age 34 years (interquartile range [IQR] 29-43), median disease duration 10 years (IQR: 9-14), mean ± standard deviation (SD) glycated haemoglobin (HbA 1c ) 8.4 ±1.4%. Fifty patients had at least one microangiopathic complication. Intima-media thickness (IMT) of the common carotid artery was measured using high resolution ultrasonography. Arterial stiffness was assessed using digital volume pulse analysis and tonometric measurement of wave reflection and central haemodynamics. 120.2 ±19.4% vs. 110.5 ±17.1%, p = 0.016) and higher peripheral augmentation index (PAI x ) (65.7 ±18.1% vs. 57.2 ±14.9%, p = 0.023). In the logistic regression analysis, the duration of diabetes, systolic and diastolic blood pressure, postprandial glycaemia, HbA 1c and triglycerides predicted the presence of diabetic microangiopathy independently of age and sex. The CIMT, CAI x and PAI x were associated with the presence of diabetic microangiopathy only in the univariate model. Conclusions: In type 1 diabetic patients with microangiopathic complications, increased carotid IMT and arterial stiffness were observed. The study confirms the role of traditional risk factors for late diabetic complications, such as the duration of the disease and metabolic control in the development of microangiopathy.

Arterial Stiffness Is Associated With Carotid Intraplaque Hemorrhage in the General Population

“…This hypothesis is consistent with several studies that showed a relation between reduced compliance in large arteries and pathological conditions that are related with flow disturbances in the microcirculation. [31][32][33][34] In a cross-sectional population study, increased brachial-ankle PWV affected the microcirculation in brains and kidneys in a way leading to cerebral asymptomatic lacunar infarction 33 and renal albuminuria, 34 respectively. In another population study that included 443 healthy subjects, PWV was significantly associated with silent cerebral microbleeds on brain MRI.…”

“…31 Also, one study reported a relation between arterial stiffness and microangiopathy in a diabetes mellitus type 1 population. 32 On a local level, another aspect that needs to be considered is the fluid dynamics, which can underlie the connection between arterial stiffness and atherosclerotic plaque. Although flow in the common carotid artery has a laminar profile, this can evolve to velocity profile skewing at the carotid bifurcation, leading to regions in which the wall shear stress is low.…”

C‐Reactive protein and soluble intracellular adhesion molecule‐1 are related to pulse wave reflection in type 1 diabetes 在1型糖尿病中C‐反应蛋白以及可溶性细胞间黏附分子在1与脉冲波反射有关

“…The absorbance of the test material was measured at wavelengths of 450 and 540 nm. The concentrations of the different parameters were determined from a standard curve …”

Insulin therapy and lipoproteins in patients with type 1 diabetes

“…Predictors of the occurrence of diabetic microangiopathy have been identified, showing that beyond the duration of diabetes, systolic and diastolic blood pressure, postprandial glucose, HbA 1c levels also elevated serum TG and LDL cholesterol levels were responsible for the increased risk of angiopathy [14].…”