title: Microangiopathy of large artery wall: a neglected complication of diabetes mellitus.
abstract: OBJECTIVE
  To test the concept that diabetic patients with microangiopathy of the retinal microcirculation would also show an involvement of the carotid adventitial microcirculation, we aimed to assess the status of the vasa vasorum (VV) signal, measured by contrast-enhanced carotid ultrasound imaging, in type 2 diabetic patients with and without retinopathy.
  
  
  RESULTS
  Using contrast-enhanced ultrasound imaging, we quantified the signal of the VV of the common carotid artery. We investigated two subgroups of type 2 diabetic patients who did not have previous cardiovascular disease: 51 with retinopathy and 56 without retinopathy. The reference VV signal was measured in a group of 65 healthy volunteers as the ratio of the contrast agent signal of the VV and that of the lumen of the artery. Patients and volunteers also underwent a clinical evaluation. The reference VV signal in the group of 65 healthy volunteers was 0.562 (SD = 0.142). Patients with diabetic retinopathy showed a higher mean adventitial VV signal (0.700; SD = 0.150) than those without retinopathy (0.621; SD = 0.120) (P < 0.0039). This difference remained highly significant after adjusting for cardiovascular risk factors. Common carotid intima-media thickness and carotid plaque prevalence were not different between diabetic subgroups.
  
  
  CONCLUSIONS
  Type 2 diabetic patients with retinopathy show increased angiogenesis of the VV of the common carotid artery. This suggests the existence of a diabetic microangiopathic complication affecting the wall of the large arteries that may be an important contributor to the cardiovascular disease burden in diabetes mellitus.
authors.affiliation: Department of Nephrology, Hospital Universitari Arnau de Vilanova, Rovira Roure 80, 25198 Lleida, Spain.
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Arcidiacono
authors.forename: Alicia
authors.initials: A
authors.lastname: Traveset
authors.forename: Esther
authors.initials: E
authors.lastname: Rubinat
authors.forename: Emilio
authors.initials: E
authors.lastname: Ortega
authors.forename: Angels
authors.initials: A
authors.lastname: Betriu
authors.forename: Marta
authors.initials: M
authors.lastname: Hernández
authors.forename: Elvira
authors.initials: E
authors.lastname: Fernández
authors.forename: Didac
authors.initials: D
authors.lastname: Mauricio
mesh_terms: D000328:Adult; D063194:Adventitia / Q000000981:diagnostic imaging; D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014651:Vasa Vasorum / Q000000981:diagnostic imaging