Relationship of adiposity to subclinical atherosclerosis in obese patients with type 2 diabetes.
OBJECTIVE
There is an increased prevalence of macrovascular disease in type 2 diabetes. The pathogenesis has been related to metabolic risk factors, insulin resistance, and obesity. One of the strongest predictors is the presence of subclinical atherosclerosis. This study was designed to examine the relationship between obesity and regional patterns of adiposity, insulin resistance, and five independent measures of subclinical atherosclerosis.


METHODS
Fifty-two overweight and obese men and women with type 2 diabetes of relatively short known duration were examined. Measures of subclinical vascular disease were assessment of arterial stiffness by pulse wave velocity, ultrasound measurement of the carotid artery intimal-medial thickness and plaque index, and measurement of the extent of coronary and aortic calcification using electron beam computed tomography. Insulin resistance was measured using the hyperinsulinemic euglycemic clamp. Body composition was measured using DXA and computed tomography.


RESULTS
Adiposity was a strong determinant of pulse wave velocity. Carotid intimal-medial thickness was correlated with age, low-density lipoprotein-cholesterol, and hyperglycemia, but not with adiposity. Hyperglycemia and plasma activator inhibitor-1 were significant correlates of the carotid artery plaque index. Coronary calcium scores were significantly correlated with age and interleukin-6 and significantly and negatively correlated to insulin sensitivity index.


CONCLUSIONS
These findings suggest that obesity may play an important role in the early phase of subclinical macrovascular disease related to vessel stiffness, whereas hyperglycemia and insulin resistance in conjunction with other risk factors have important roles in progression from vessel stiffness to atheroma formation in type 2 diabetes.
Hegazi
Refaat A F
RA
Department of Medicine, School of Medicine and Graduate School of Public Health, University of Pittsburgh, Pennsylvania, USA.
Sutton-Tyrrell
Kim
K
Evans
Robert W
RW
Kuller
Lewis H
LH
Belle
Steven
S
Yamamoto
Monica
M
Edmundowicz
Daniel
D
Kelley
David E
DE
D015502:Absorptiometry, Photon; D000273:Adipose Tissue / Q000378:metabolism; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition / Q000502:physiology; D002114:Calcinosis / Q000473:pathology; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications* / Q000473:pathology; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000473:pathology; D005260:Female; D015309:Glucose Clamp Technique; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009765:Obesity; D014057:Tomography, X-Ray Computed; D017539:Tunica Intima / Q000502:physiology; D018608:Ultrasonography, Doppler
D001786:Blood Glucose; D007328:Insulin