Cerebrovascular disease in diabetes mellitus: the role of carotid intima-media thickness.
OBJECTIVE
Cerebrovascular disease in diabetes appears to be less considered than coronary and peripheral disease, the reason being the intrinsic difficulty in finding available diagnostic tools for its early identification. Among these, carotid artery intima-media thickness (cIMT) represents the simplest measurable parameter for pre-atherosclerotic lesions in extra-cranic arteries.


METHODS
The role of cIMT as a surrogate marker of cerebral atherosclerosis and predictor of stroke, its relationship to microangiopathy and chronic inflammation, along with its role as an outcome parameter in anti-hyperglycemic therapeutical intervention trials in type 2 and 1 diabetes mellitus are discussed in this paper.


CONCLUSIONS
Carotid IMT is increased in diabetes. It is an independent predictor of stroke, in particular of the ischemic subtype, and of stroke recurrence in diabetic, as well as in non-diabetic populations. A possible role of cIMT as a predictor of microangiopathy has also been suggested, but it needs further investigation. A weak association with chronic inflammation has been demonstrated in diabetic patients. Carotid IMT has been successfully employed as an outcome parameter for several anti-hyperglycemic therapeutic trials. However data on cIMT as a predictor of cerebrovascular disease are scarce in diabetic patients, particularly in type 1 diabetes, and more studies are needed to define the risk of cerebrovascular disease in diabetic patients.
Vigili de Kreutzenberg
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Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy. saula.dekreutzenberg@unipd.it
Tiengo
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Avogaro
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D002340:Carotid Artery Diseases / Q000453:epidemiology* / Q000473:pathology*; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology