title: Carotid Intima-Media Thickness, Ankle-Arm Index, and Inflammation Profile in Mexican Patients with Early and Late Onset Type 2 Diabetes.
abstract: BACKGROUND
  Type 2 diabetes is strongly linked to an increased incidence of cardiovascular outcomes. Carotid artery intima-media thickness and ankle-arm index are non-invasive complementary measures as subclinical markers of atherosclerosis.
  
  
  OBJECTIVE
  To evaluate the association of carotid intima-media thickness, ankle-arm index, and inflammation profile in Mexican patients with early- and late-onset type 2 diabetes mellitus.
  
  
  METHODS
  We included 145 subjects at an academic medical center: 77 patients with early-onset (< 40 years of age) and 33 patients with late-onset (≥ 40 years) type 2 diabetes mellitus, and 35 healthy volunteers. Clinical history, anthropometrics, blood chemistry, lipids profile, glycosylated hemoglobin A1c, cytokines, and high-sensitivity C-reactive protein were determined; carotid and lower limb ultrasound were taken. Groups were compared with ANOVA or Kruskal-Wallis, Student's t or Mann-Whitney U. Spearman or Pearson correlation and logistic regression analysis were used.
  
  
  RESULTS
  There were anthropometric and biochemical differences between the three groups. Concentrations of interleukin-1β, -4 and -6 were significantly higher in patients with late versus early onset diabetes. There were differences in carotid intima-media thickness and ankle-arm index between early and late onset. Age, body mass index, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, waist circumference, and glycosylated hemoglobin A1c showed direct correlation with carotid intima-media thickness, while ankle-arm index showed inverse correlation with blood pressure, glycosylated hemoglobin A1c, time with disease, age at onset, triglycerides, and fibrinogen. Multivariate analysis showed an association between carotid intima-media thickness and disease duration; ankle-arm index with disease duration and high-sensitivity C-reactive protein; while only body mass index associated with end diastolic flow velocity.
  
  
  CONCLUSIONS
  Our findings suggest that carotid intima-media thickness and ankle-arm index are associated with inflammation markers and could be included in the evaluation of type 2 diabetes mellitus patients, according to disease onset and duration. There are important differences in interleukin concentrations between early- and late-onset type 2 diabetes mellitus. Additionally, measurement of high-sensitivity C-reactive protein is suggested in patients with abnormal ankle-arm index.
authors.affiliation: Radiodiagnostic Service, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México.
authors.forename: Alicia
authors.initials: A
authors.lastname: Contreras-Rodríguez
authors.affiliation: Medical Research Unit in Clinical Epidemiology, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México.
authors.forename: Rita A
authors.initials: RA
authors.lastname: Gómez-Díaz
authors.affiliation: Radiodiagnostic Service, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México.
authors.forename: Janet
authors.initials: J
authors.lastname: Tanus-Hajj
authors.affiliation: Medical Research Unit in Clinical Epidemiology, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México.
authors.forename: Juan O
authors.initials: JO
authors.lastname: Talavera
authors.affiliation: Medical Research Unit in Clinical Epidemiology, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México.
authors.forename: Rafael
authors.initials: R
authors.lastname: Mondragón-González
authors.affiliation: Medical Research Unit in Clinical Epidemiology, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Wacher
mesh_terms: D000328:Adult; D017668:Age of Onset; D055109:Ankle Brachial Index; D050197:Atherosclerosis; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D059168:Carotid Intima-Media Thickness; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology*; D053583:Interleukin-1beta / Q000378:metabolism; D015847:Interleukin-4 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008055:Lipids / Q000097:blood; D008297:Male; D008800:Mexico; D008875:Middle Aged; D055815:Young Adult
chemical_list: D053583:Interleukin-1beta; D015850:Interleukin-6; D008055:Lipids; D015847:Interleukin-4; D002097:C-Reactive Protein