Microangiopathy is independently associated with presence, severity and composition of carotid atherosclerosis in type 2 diabetes

• Published in: Nutrition, metabolism, and cardiovascular diseases metabolism, and cardiovascular diseases, 2011-04, Vol.21 (4), p.286-293
• Main Authors: Vigili de Kreutzenberg, S, Coracina, A, Volpi, A, Fadini, G.P, Frigo, A.C, Guarneri, G, Tiengo, A, Avogaro, A
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; atherosclerosis; Calcinosis - etiology; calcium; Cardiovascular; carotid arteries; Carotid Artery Diseases - blood; Carotid Artery Diseases - complications; Carotid Artery Diseases - physiopathology; Carotid atherosclerosis; Carotid Stenosis - epidemiology; Cholesterol, HDL - blood; Cohort Studies; Cross-Sectional Studies; Diabetes Mellitus, Type 2 - complications; Diabetic Angiopathies - epidemiology; Diabetic Nephropathies - epidemiology; diabetic retinopathy; Diabetic Retinopathy - epidemiology; Female; high density lipoprotein cholesterol; Humans; Italy - epidemiology; kidney diseases; Male; males; Microangiopathy; Microvessels - physiopathology; myocardial ischemia; Myocardial Ischemia - epidemiology; noninsulin-dependent diabetes mellitus; patients; Plaque, Atherosclerotic - chemistry; Plaque, Atherosclerotic - etiology; Prevalence; regression analysis; Severity of Illness Index; Sex Factors; smoking (habit); Smoking - adverse effects; Type 2 diabetes mellitus; ultrasonics
• ISSN: 0939-4753; 1590-3729
• DOI: 10.1016/j.numecd.2009.10.003

Abstract Background and aims Common mechanisms for the development of micro- and macroangiopathic diabetic complications have been suggested. We aimed to cross-sectionally investigate strength and characteristics of the association between carotid atherosclerosis and microangiopathy in type 2 diabetic patients. Methods and results Common carotid artery intima–media thickness (cIMT), carotid plaque (CP) type and degree of stenosis were evaluated by ultrasound, along with the determination of anthropometric parameters, HbA1c, lipid profile, assessment of diabetic retinopathy and nephropathy, in 662 consecutive patients with type 2 diabetes mellitus (T2DM). Patients were divided according to high/low cIMT, presence/absence of CP and of retinopathy and nephropathy. Patients with CP were older, more prevalently males, past smokers, had longer diabetes duration, significantly lower HDL cholesterol and more prevalent ischemic heart disease (all p < 0.05) as compared to those with cIMT < 1 mm. Microangiopathies were more prevalent in patients with CP than in those without. At multivariate logistic regression, factors independently associated with the presence of CP were age, past smoke, HDL cholesterol, retinopathy and retinopathy plus nephropathy. A significant independent correlation of CP stenosis with stage of retinopathy and nephropathy was found. Finally, echolucent CPs were associated with a lower prevalence of proliferative retinopathy than CP containing calcium deposits. Conclusion In T2DM, retinopathy, alone or in combination with nephropathy, is independently associated to CP, and severity of microangiopathy correlates with severity of carotid atherosclerosis. These observations, together with the different prevalence of proliferative retinopathy according to CP types, point to possible common pathogenic mechanisms in micro- and macrovascular complications.