Abstract
BackgroundPatients with peripheral artery disease (PAD) are at increased risk of secondary events, which is exaggerated in the presence of type 2 diabetes mellitus. Diabetes is associated with a systemic pro-inflammatory state. We therefore investigated the cumulative impact of PAD and type 2 diabetes on carotid arterial wall inflammation. As recent data suggest a detrimental role of exogenous insulin on cardiovascular disease, we also included a group of insulin users.Results 18F-fluorodeoxyglucose positron emission tomography with computed tomography (18F-FDG PET/CT) imaging showed increased carotid arterial wall inflammation, assessed as target-to-background ratio (TBR), in PAD patients without diabetes (PAD-only: n = 11, 1.97 ± 0.57) compared with matched controls (n = 12, 1.49 ± 0.57; p = 0.009), with a significant further TBR increase in PAD patients with type 2 diabetes (PAD-DM, n = 23, 2.90 ± 1, p = 0.033 vs PAD-only). TBR of insulin users (n = 12, 3.31 ± 1.14) was higher compared with patients on oral medication only (n = 11, 2.44 ± 0.76, p = 0.035), despite comparable PAD severity (Fontaine stages), BMI and CRP. Multivariate regression analysis showed that Hba1c and plasma insulin levels, but not dose of exogenous insulin, correlated with TBR.ConclusionsConcurrent diabetes significantly augments carotid arterial wall inflammation in PAD patients. A further increase in those requiring insulin was observed, which was associated with diabetes severity, rather than with the use of exogenous insulin itself.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0397-x) contains supplementary material, which is available to authorized users.
Highlights
Patients with peripheral artery disease (PAD) are at increased risk of secondary events, which is exaggerated in the presence of type 2 diabetes mellitus
The PAD-DM group consisted of 11 patients using oral antidiabetic drugs only (PADNIDDM, age 64 ± 7) and 12 patients using insulin (PAD-Insulin dependent diabetes mellitus (IDDM), age 63 ± 7)
Anti-hypertensive medication was more frequently used in subjects with diabetes
Summary
Patients with peripheral artery disease (PAD) are at increased risk of secondary events, which is exaggerated in the presence of type 2 diabetes mellitus. There is only limited data on the relation between PAD and arterial wall inflammation, despite evidence of a systemic pro-inflammatory state in PAD patients and the high rate of events in other vascular territories. Patients with PAD and concomitant type 2 diabetes are at a two-fold increased risk of cardiovascular death compared with PAD-patients without diabetes [10] Amongst others, this has been suggested to relate to the pro-inflammatory effects of hyperglycaemia and/or hyperinsulinemia [11, 12]. There is currently no direct evidence that increased systemic arterial wall inflammation may be implicated in the cumulative impact on cardiovascular risk of PAD and type 2 diabetes, nor has the association between exogenous insulin use and arterial wall inflammation been previously investigated
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