Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study.
BACKGROUND
There is a need to develop and validate surrogate markers of cardiovascular disease (CVD) in subjects with diabetes. The macrovascular changes associated with diabetes include aggravated atherosclerosis, increased arterial stiffness and endothelial dysfunction. The aim of this study was to determine which of these factors is most strongly associated with clinically manifest cardiovascular events.


METHODS
Vascular changes were measured in a cohort of 458 subjects with type 2 diabetes (T2D) and CVD (myocardial infarction, stroke or lower extremity arterial disease), 527 subjects with T2D but without clinically manifest CVD and 515 subjects without T2D and with or without CVD.


RESULTS
Carotid intima-media thickness (IMT) and ankle-brachial pressure index were independently associated with the presence of CVD in subjects with T2D, whereas pulse wave velocity and endothelial function provided limited independent additive information. Measurement of IMT in the carotid bulb provided better discrimination of the presence of CVD in subjects with T2D than measurement of IMT in the common carotid artery. The factors most significantly associated with increased carotid IMT in T2D were age, disease duration, systolic blood pressure, impaired renal function and increased arterial stiffness, whereas there were no or weak independent associations with metabolic factors and endothelial dysfunction.


CONCLUSIONS
Measures of atherosclerotic burden are associated with clinically manifest CVD in subjects with T2D. In addition, vascular changes that are not directly related to known metabolic risk factors are important in the development of both atherosclerosis and CVD in T2D. A better understanding of the mechanisms involved is crucial for enabling better identification of CVD risk in T2D.
Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK.
A C
AC
Shore
Medical Research Institute, University of Dundee, Dundee, UK.
H M
HM
Colhoun
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
A
A
Natali
Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.
C
C
Palombo
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
G
G
Östling
Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK.
K
K
Aizawa
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
C
C
Kennbäck
Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK.
F
F
Casanova
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
M
M
Persson
Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK.
K
K
Gooding
Diabetes and Vascular Medicine, University of Exeter Medical School and NIHR Exeter Clinical Research Facility, Exeter, UK.
P E
PE
Gates
Medical Research Institute, University of Dundee, Dundee, UK.
F
F
Khan
Medical Research Institute, University of Dundee, Dundee, UK.
H C
HC
Looker
Medical Research Institute, University of Dundee, Dundee, UK.
F
F
Adams
Medical Research Institute, University of Dundee, Dundee, UK.
J
J
Belch
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
S
S
Pinnoli
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
E
E
Venturi
Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy.
C
C
Morizzo
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
I
I
Goncalves
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
C
C
Ladenvall
Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
J
J
Nilsson
D000368:Aged; D001161:Arteriosclerosis / Q000000981:diagnostic imaging*; D002318:Cardiovascular Diseases / Q000473:pathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology; D004730:Endothelium, Vascular / Q000503:physiopathology; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D059289:Vascular Stiffness / Q000502:physiology
cardiovascular disease; diabetes mellitus; risk factors; vasculature