Diabetes and carotid artery disease: a narrative review

Abstract

Diabetes mellitus (DM) has been linked to an increased prevalence and severity of carotid artery disease, as well as polyvascular disease. Carotid disease is also associated with obesity and abnormal periorgan and intra-organ fat (APIFat) deposition (i.e., excess fat accumulation in several organs such as the liver, heart and vessels). In turn, DM is associated with APIFat. The coexistence of these comorbidities confers a greater risk of vascular events. Clinicians should also consider that carotid bruits may predict cardiovascular risk. DM has been related to a greater risk of adverse outcomes after carotid endarterectomy or stenting. Whether modifying risk factors (e.g., glycaemia and dyslipidaemia) in DM patients can improve the outcomes of these procedures needs to be established. Furthermore, DM is a risk factor for contrastinduced acute kidney injury (CI-AKI). The latter should be recorded in DM patients undergoing carotid stenting since it can influence both short-and long-term outcomes. From a pathophysiological perspective, functional changes in the carotid artery may precede morphological ones. Furthermore, carotid plaque characteristics are increasingly being studied in terms of vascular risk stratification and monitoring shortterm changes attributed to treatment. The present narrative review discusses the recent (2019) literature on the associations between DM and carotid artery disease. Physicians and vascular surgeons looking after patients with carotid disease and DM should consider these links that may influence outcomes. Further research in this field is also needed to optimise the treatment of such patients.

Hyperbaric Oxygen Therapy and Vascular Complications in Diabetes Mellitus

“…38,42 Diabetes mellitus has been linked with carotid artery pathology and may have a negative influence on the outcome of surgical procedures required for these patients. 43 Whether modifying risk factors (eg, glycemia and dyslipidemia) in patients with DM can improve the outcomes of these procedures needs to be established. Furthermore, DM is a risk factor for contrast-induced acute kidney injury.…”

“…44 The latter should be recorded in patients with DM undergoing carotid stenting since it can influence both short- and long-term outcomes. 43 From a pathophysiological perspective, functional changes in the carotid artery may precede morphological ones. 43,45,46…”

“…43 From a pathophysiological perspective, functional changes in the carotid artery may precede morphological ones. 43,45,46…”

Narrative Review of Carotid disease and the kidney

“…The link between carotid atherosclerosis and GFR, weak in patients with normal kidney function and in those with diabetes, increases in patients with CKD (43)(44)(45)(46)(47)(48). However, it is difficult to dissect the role of CKD from the cluster of risk factors that may accompany carotid atherosclerosis (e.g., hypertension, diabetes, dyslipidaemia and inflammation) in these patients (49)(50)(51). In this context, qualitative and quantitative lipid abnormalities have been reported in these patients (52)(53)(54)(55) and linked to both carotid atherosclerosis (55)(56)(57)(58) and CKD progression (59).…”

Diabetes Mellitus and Noncardiac Atherosclerotic Vascular Disease—Pathogenesis and Pharmacological Treatment Options

“…A more detailed overview of the link between DM and carotid disease is available elsewhere. 55 Peripheral Arterial Disease Epidemiology. One-third of patients hospitalized because of PAD have DM.…”