title: Factors associated with carotid intima-media thickness and carotid plaques in type 2 diabetic patients.
abstract: OBJECTIVE
  Factors associated with carotid atherosclerosis are unclear in type 2 diabetic patients. The aim was to investigate the independent correlates of carotid intima-media thickness (IMT) and plaques in these individuals.
  
  
  METHODS
  In a cross-sectional study, we measured carotid IMT at three sites (common carotid, bifurcation and internal carotid artery) and the severity of extracranial carotid artery (ECCA) atherosclerosis by plaque score in 441 type 2 diabetic patients. Nontraditional cardiovascular risk factors [ambulatory blood pressures (BPs), aortic stiffness, C-reactive protein and ankle-brachial index) were obtained. Multivariate linear and logistic regressions assessed the independent correlates of carotid IMT and ECCA plaque score.
  
  
  RESULTS
  Patients with greater carotid IMT or plaque scores had worse clinical and laboratory profile than those with lower IMT and plaque scores, including higher BPs, aortic stiffness and prevalences of diabetic complications. On multivariate analysis, carotid IMT and plaques were mainly associated with older age, male sex, current-past smoking and ambulatory BPs, but not with clinic BPs. Night-time pulse pressure was the most important modifiable determinant of increased carotid IMT. No microvascular complication was independently associated with carotid atherosclerosis, except retinopathy for plaque score. Additionally, internal carotid IMT and plaque score were associated with ankle-brachial index in the subgroup of patients without macrovascular diseases.
  
  
  CONCLUSIONS
  In type 2 diabetic patients, older age, male sex, smoking status and ambulatory BPs, particularly night-time pulse pressure, were the main independent correlates of ultrasonographic carotid atherosclerosis. This finding reinforces the importance of ambulatory BP monitoring in type 2 diabetes management.
authors.affiliation: Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Claudia R L
authors.initials: CR
authors.lastname: Cardoso
authors.forename: Carlos E C
authors.initials: CE
authors.lastname: Marques
authors.forename: Nathalie C
authors.initials: NC
authors.lastname: Leite
authors.forename: Gil F
authors.initials: GF
authors.lastname: Salles
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D050197:Atherosclerosis; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D002339:Carotid Arteries / Q000473:pathology; D002340:Carotid Artery Diseases / Q000150:complications / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058226:Plaque, Atherosclerotic; D012307:Risk Factors; D059289:Vascular Stiffness
chemical_list: D002097:C-Reactive Protein