Recent Advances of Intervention to Inhibit Progression of Carotid Intima-Media Thickness in Patients With Type 2 Diabetes Mellitus

Abstract

Background and Purpose-Type 2 diabetes is associated with a high cardiovascular morbidity and mortality. Recent advances of intervention studies in type 2 diabetes with use of carotid intima-media thickness (CIMT) measurement as a surrogate end point may allow for better understanding of the undetermined process of atherosclerosis, the effect of interventions, and the usefulness of CIMT to inhibit events of cardiovascular disease. Summary of Review-Data were available from 11 studies (nϭ1578) in subjects with type 2 diabetes (including impaired glucose tolerance, nϭ132) that evaluated the effect of interventions on change in CIMT. The overall weighed rate of change in mean CIMT based on data among control groups (ie, type 2 diabetes without interventions) was 0.034 mm/y (95% CI, 0.029 to 0.039; median SD, 0.054), in which mean HbA 1c was 7.86% (95% CI, 7.72 to 8.00; median SD, 1.5). A significant close correlation of HbA 1c with rate of CIMT change was found (R 2 ϭ0.35, Pϭ0.01). Agents for lowering of blood glucose, platelet activation, or blood pressure significantly reduced the CIMT increase, independent of blood glucose control. This implies that other mechanisms of such agents to diminish CIMT increase should be explored. Conclusions-CIMT measurement may contribute to elucidating the short-and/or long-term effect of interventions on the rate of change in CIMT in relation to the levels of various risk factors. Although the method needs further standardization, pharmacological interventions are likely to inhibit progression of CIMT, leading to a reduction of cardiovascular events.

Alogliptin, a Dipeptidyl Peptidase 4 Inhibitor, Prevents the Progression of Carotid Atherosclerosis in Patients With Type 2 Diabetes: The Study of Preventive Effects of Alogliptin on Diabetic Atherosclerosis (SPEAD-A)

“…In addition, Nagashima et al (35) demonstrated Our results showed a low rate of progression of IMT, even in the conventional group (0.005 mm). Generally, the rate of carotid IMT progression is high in untreated patients with T2DM (24). However, few studies reported that progression of carotid IMT could almost be prevented in patients with T2DM, even in the control/placebo group of intervention trials (24), although the reports were not always consistent (24,37).…”

“…Generally, the rate of carotid IMT progression is high in untreated patients with T2DM (24). However, few studies reported that progression of carotid IMT could almost be prevented in patients with T2DM, even in the control/placebo group of intervention trials (24), although the reports were not always consistent (24,37). The exact reason for differences among these studies was not investigated, but we believe that several factors, such as differences in T2DM status (e.g., HbA 1c , type of medications), control of several CV risk factors (e.g., stage of atherosclerosis), prevalence of complications (e.g., nephropathy), duration of the follow-up period, and race, can affect carotid IMT progression.…”

“…The progression of carotid IMT in patients with T2DM is considered to be 0.034 6 0.054 mm/year, and a 1% improvement in the HbA 1c value is associated with 0.02 mm/year improvement in IMT (24). Therefore, in the 2-year observation period, registration of at least 324 patients was required to obtain 90% power to detect a difference of 0.04 mm in IMT between the two treatment groups, assuming a SD of 0.108, 5% dropout, and 0.05 level of significance.…”

Microalbuminuria Is Common in Japanese Type 2 Diabetic Patients

“…Intervention studies with ARB (18), pioglitazone (19,20), and acarbose (20 -22) have yielded a reduction not only in UAE but also in cardiovascular morbidity. The facts would emphasize the importance of multifactorial treatment for modifiable risks aiming at reducing UAE and associated risks.…”

Long-Term Effects of Pioglitazone on Carotid Atherosclerosis in Japanese Patients with Type 2 Diabetes without a Recent History of Macrovascular Morbidity

“…Diabetes, which confers an increased risk of CV disease, accelerates carotid IMT progression 21) . In a recent review of 11 carotid IMT intervention trials in diabetes, the mean carotid IMT progression rate in type 2 diabetic subjects without intervention was 0.034 mm/year (95% CI, 0.029 to 0.039; median SD, 0.054) 22) . Several studies have assessed the effect of various therapeutic agents on carotid IMT as a measure of atherosclerosis.…”