Carotid artery intima-media complex thickening in patients with relatively long-surviving type 1 diabetes mellitus

J Diabetes Complications. Sep-Oct 2006;20(5):280-4. doi: 10.1016/j.jdiacomp.2005.07.012.

Abstract

Objective: The factors responsible for premature coronary atherosclerosis in patients with type 1 diabetes are ill defined. We therefore assessed carotid intima-media complex thickness (IMT) in relatively long-surviving patients with type 1 diabetes as a marker of atherosclerosis and correlated this with traditional risk factors.

Design: Cross-sectional study of 148 patients with relatively long-surviving (>18 years) type 1 diabetes (76 men and 72 women) attending the Centre for Diabetes and Endocrinology, Johannesburg.

Methods: The mean common carotid artery IMT and presence or absence of plaque was evaluated by high-resolution B-mode ultrasound. Their median age was 48 years and duration of diabetes 26 years (range 18-59 years). Traditional risk factors (age, duration of diabetes, glycemic control, hypertension, smoking and lipoprotein concentrations) were recorded. Three response variables were defined and modeled. Standard multiple regression was used for a continuous IMT variable, logistic regression for the presence/absence of plaque and ordinal logistic regression to model three categories of "risk."

Results: The median common carotid IMT was 0.62 mm (range 0.44-1.23 mm) with plaque detected in 28 cases. The multiple regression model found significant associations between IMT and current age (P=.001), duration of diabetes (P=.033), BMI (P=.008) and diagnosed hypertension (P=.046) with HDL showing a protective effect (P=.022). Current age (P=.001) and diagnosed hypertension (P=.004), smoking (P=.008) and retinopathy (P=.033) were significant in the logistic regression model. Current age was also significant in the ordinal logistic regression model (P<.001), as was total cholesterol/HDL ratio (P<.001) and mean HbA(1c) concentration (P=.073).

Conclusions: The major factors influencing common carotid IMT in patients with relatively long-surviving type 1 diabetes are age, duration of diabetes, existing hypertension and HDL (protective) with a relatively minor role ascribed to relatively long-standing glycemic control.

MeSH terms

  • Adult
  • Aged
  • Atherosclerosis / diagnostic imaging
  • Atherosclerosis / epidemiology*
  • Atherosclerosis / pathology
  • Carotid Arteries / diagnostic imaging
  • Carotid Arteries / pathology
  • Carotid Artery Diseases / complications
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / epidemiology*
  • Carotid Artery Diseases / pathology
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / diagnostic imaging
  • Diabetes Mellitus, Type 1 / pathology*
  • Diabetic Angiopathies / diagnostic imaging
  • Diabetic Angiopathies / epidemiology*
  • Diabetic Angiopathies / pathology
  • Female
  • Humans
  • Hypertension / complications
  • Hypertension / diagnostic imaging
  • Hypertension / pathology
  • Logistic Models
  • Male
  • Middle Aged
  • South Africa / epidemiology
  • Statistics, Nonparametric
  • Tunica Intima / diagnostic imaging
  • Tunica Intima / pathology
  • Tunica Media / diagnostic imaging
  • Tunica Media / pathology
  • Ultrasonography