title: Diabetes and progression of carotid atherosclerosis: the insulin resistance atherosclerosis study.
abstract: OBJECTIVE
  We sought to determine the rate of progression of carotid atherosclerosis in persons with normal glucose tolerance, impaired glucose tolerance, and undiagnosed and diagnosed type 2 diabetes.
  
  
  RESULTS
  The Insulin Resistance Atherosclerosis Study (IRAS) is an observational cohort study in which 1192 men and women were examined at a 5-year interval. Participants of 3 ethnic groups (non-Hispanic white, African American, and Hispanic) were selected from the general population to represent a range of glucose tolerance. Baseline and follow-up ultrasound studies were obtained to estimate progression of common carotid artery (CCA) and internal carotid artery (ICA) intimal-medial thickness (IMT). Baseline glucose tolerance status was defined by an oral glucose tolerance test and World Health Organization criteria. In persons with normal glucose tolerance, progression of CCA IMT was 3.8 microm/y, and ICA IMT, 17.7 microm/y. In both CCA and ICA, progression of IMT, unadjusted for cardiovascular disease (CVD) risk factors, was approximately twice the rate in persons with diabetes than in those with normal or impaired glucose tolerance. Adjustment for CVD risk factors attenuated these differences somewhat in both sites of the carotid artery. Persons with undiagnosed diabetes had a greater ICA IMT progression rate than did persons with diagnosed diabetes (33.9 microm/y vs 26.6 microm/y, P=NS). Progression rates did not differ between persons with normal and impaired glucose tolerance.
  
  
  CONCLUSIONS
  Progression of carotid atherosclerosis is accelerated in persons with diabetes. Progression of ICA IMT is most pronounced in persons with undiagnosed diabetes. Early identification of diabetes and CVD risk factor control might reduce its atherosclerotic complications.
authors.affiliation: Department of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1063, USA. lwgnkcht@wfubmc.edu
authors.forename: Lynne E
authors.initials: LE
authors.lastname: Wagenknecht
authors.forename: Daniel
authors.initials: D
authors.lastname: Zaccaro
authors.forename: Mark A
authors.initials: MA
authors.lastname: Espeland
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Karter
authors.forename: Daniel H
authors.initials: DH
authors.lastname: O'Leary
authors.forename: Steven M
authors.initials: SM
authors.lastname: Haffner
mesh_terms: D000886:Anthropometry; D044383:Black People; D001786:Blood Glucose / Q000032:analysis; D002140:California / Q000453:epidemiology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000453:epidemiology; D013781:Texas / Q000453:epidemiology; D014463:Ultrasonography; D044465:White People; D001741:Black or African American
chemical_list: D001786:Blood Glucose