Carotid Intima-Media Thickness: An Index for Subclinical Atherosclerosis in Type 1 Diabetes

Abstract

Cardiovascular disease and the development of coronary artery atherosclerosis play a pivotal role in increasing mortality in patients with diabetes. The aim of the present study was to determine the presence of subclinical atherosclerosis (measured as carotid intima-media thickness [cIMT] and to study possible associated risk factors in adolescents with type 1 diabetes. Forty type 1 diabetic subjects, aged 11-30 years, with duration of diabetes 3-25 years and 40 normal healthy controls, were included. Blood pressure (BP) measurement, as well as screening for diabetic complications, was performed. Lipid profile, albumin/creatinine ratio, renal functions and glycosylated hemoglobin (HB A(1)c) were assayed. Carotid intima-media thickness (cIMT) was measured using ultrasound. The mean aggregate cIMT was higher in diabetics than controls (0.6 mm 00 +/- 0.1 vs. 0.4 mm +/- 0.1, p = 0.000). Moreover, it was higher in patients with positive family history of type 2 diabetes than in those with negative family history (mean 0.7 mm +/- 0.1 vs. 0.6 mm +/- 0.1, p = 0.018). cIMT was found to positively correlate with: age in both diabetics and controls (r = 0.76, p = 0.000, r = 0.74, p = 0.000 respectively), body mass index (BMI) in diabetics but not controls (r = 0.82, p = 0.000, r = 0.30, p = 0.06 respectively). In diabetics, mean aggregate cIMT positively correlated with duration of diabetes (r = 0.66, p = 0.000), systolic blood pressure (r = 0.82, p = 0.000), diastolic BP (r = 0.83, p = 0.000), as well as HB A1c (r = 0.40, p = 0.004) and correlated negatively with high density lipoprotein -cholesterol (HDL-C) (r = -0.88, p = 0.000). As cardiovascular morbidity is high in diabetes, non-invasive methods for monitoring vascular changes as cIMT might be useful in clinical practice for early diagnosis of subclinical atherosclerosis, which can allow for strategies designed to reduce the cardiovascular event rate in those patients.

Carotid Intima-Media Thickness in Pediatric Type 1 Diabetic Patients

“…In spite of that, the difference found in the mean cIMT between control subjects and diabetic patients in our study was lower than that reported by Järvisalo et al (0.02 vs. 0.05 mm), despite the similar age and mean diabetes duration of the study samples. Other authors have reported differences in mean cIMT above or below the difference reported here; differences between case and control subjects vary from 0.01 mm (20) to 0.20 mm (13).…”

“…However, its ability to predict CHD in pediatric patients has been fairly explored (13,14). Data in pediatric populations are scant, and no publications currently exist in Hispanic patients.…”

Safety and accuracy of dual-source coronary computed tomography angiography in the pediatric population

“…[1][2][3][4] Pediatric patients with a history of cardiac transplantation, thoracic radiation therapy, and specific syndromes and systemic diseases are also at increased risk for coronary artery disease at a young age. [5][6][7][8] Catheter-based angiography is the historical standard for coronary artery evaluation. A noninvasive alternative such as coronary computed tomography angiography (CTA) was previously limited because of elevated heart rates that could compromise coronary CTA scan quality and increased sensitivity to radiation which is a special concern in the pediatric population.…”

Diabetes Mellitus; Carotid Thickness - Association of Glycemic Control

“…17 An Asian study also reveals association of age, duration of diabetes, both systolic and diastolic blood pressures and HDL levels with carotid intima-media thickness in patients with type 2 diabetes mellitus. 18 Glycemic control as represented by HbA1c in type 1 diabetes patients showed a significant relationship with CIMT only in female patients and not in male patients. 19 Our study did not show any association of glycemic control with CIMT.…”