Carotid arterial wall inflammation in peripheral artery disease is augmented by type 2 diabetes: a cross-sectional study

Abstract

BackgroundPatients with peripheral artery disease (PAD) are at increased risk of secondary events, which is exaggerated in the presence of type 2 diabetes mellitus. Diabetes is associated with a systemic pro-inflammatory state. We therefore investigated the cumulative impact of PAD and type 2 diabetes on carotid arterial wall inflammation. As recent data suggest a detrimental role of exogenous insulin on cardiovascular disease, we also included a group of insulin users.Results 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) imaging showed increased carotid arterial wall inflammation, assessed as target-to-background ratio (TBR), in PAD patients without diabetes (PAD-only: n = 11, 1.97 ± 0.57) compared with matched controls (n = 12, 1.49 ± 0.57; p = 0.009), with a significant further TBR increase in PAD patients with type 2 diabetes (PAD-DM, n = 23, 2.90 ± 1, p = 0.033 vs PAD-only). TBR of insulin users (n = 12, 3.31 ± 1.14) was higher compared with patients on oral medication only (n = 11, 2.44 ± 0.76, p = 0.035), despite comparable PAD severity (Fontaine stages), BMI and CRP. Multivariate regression analysis showed that Hba1c and plasma insulin levels, but not dose of exogenous insulin, correlated with TBR.ConclusionsConcurrent diabetes significantly augments carotid arterial wall inflammation in PAD patients. A further increase in those requiring insulin was observed, which was associated with diabetes severity, rather than with the use of exogenous insulin itself.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0397-x) contains supplementary material, which is available to authorized users.

Molecular imaging of carotid artery atherosclerosis with PET: a systematic review

“…Carotid FDG uptake in patients with atherosclerosis was mostly compared to that of subjects without atherosclerosis. Uptake of FDG [11][12][13][14][15][16][17] was more pronounced in atherosclerotic patients with than without symptoms except that in one study this difference was not present [18]. FDG uptake was higher in carotid artery specimens of patients with more severe disease (stroke vs. transient ischemic attack; maximum standardized uptake value (SUVmax), i.e.…”

PET imaging of the neurovascular interface in cerebrovascular disease

“…Inflammation within one artery is associated with increased inflammation within neighbouring arterial regions 27 . Higher carotid uptake is also observed in the presence of with dental inflammation 28 , raised low-density lipoprotein and total cholesterol levels 29 , diabetes mellitus 30 , and metabolic syndrome 31 . Carotid FDG uptake in individuals with recent acute coronary syndrome is higher than in chronic stable angina, supporting a systemic upregulation of plaque inflammation that may contribute to the clinical phenomenon where acute coronary events and ischaemic stroke occur within close temporal proximity 32 .…”

Atherosclerosis Burdens in Diabetes Mellitus: Assessment by PET Imaging

“…Below (and in Supplementary Material, Tables S1–S5 ) the literature is summarized according to five categories: Inflammation mechanisms and targeting (FDG only, see below) [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], Early detection and prevalence of arterial FDG or NaF uptake [ 30 , 31 , 32 , 33 , 34 , 35 ], Cardiovascular risk in DM [ 36 , 37 , 38 ], Disease progression [ 39 , 40 ], Therapy [ 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ]. …”

“…Seven studies dealt with the carotids [ 22 , 24 , 25 , 28 , 31 , 33 , 37 ], five with the coronary arteries [ 26 , 35 , 40 , 42 , 45 ], three with the aorta [ 23 , 29 , 44 ], and three with the femoral arteries [ 32 , 38 , 43 ]. Three studies focused on the carotids and the aorta [ 41 , 46 , 49 ], two on the coronary arteries and the thoracic aorta [ 47 , 48 ], and five on several major arteries [ 27 , 30 , 34 , 36 , 39 ].…”