Abstract
Carotid atherosclerosis (CA) and, especially, carotid artery stenosis (CAS), are associated with a high risk of cardiovascular events in subjects with type 2 diabetes (T2D). In this study, we aimed to identify risk factors and biomarkers of subclinical CA and CAS in T2D individuals. High-resolution ultrasonography of carotid arteries was performed in 389 patients. Ninety-five clinical parameters were evaluated, including diabetic complications and comorbidities; antihyperglycemic, hypolipidemic, and antihypertensive therapy; indices of glycemic control and glucose variability (GV); lipid panels; estimated glomerular filtration rate (eGFR); albuminuria; blood cell count; and coagulation. Additionally, serum levels of calponin-1, relaxin, L-citrulline, and matrix metalloproteinase-2 and -3 (MMP-2, -3) were measured by ELISA. In univariate analysis, older age, male sex, diabetes duration, GV, diabetic retinopathy, chronic kidney disease, coronary artery disease, peripheral artery disease, and MMP-3 were associated with subclinical CA. In addition to these factors, long-term arterial hypertension, high daily insulin doses, eGFR, and L-citrulline were associated with CAS. In multivariate logistic regression, age, male sex, BMI, GV, and eGFR predicted CA independently; male sex, BMI, diabetes duration, eGFR, and L-citrulline were predictors of CAS. These results can be used to develop screening and prevention programs for CA and CAS in T2D subjects.
Highlights
Cardiovascular diseases are the leading cause of death globally
Coronary artery disease (CAD) was recorded if the patient had a history of myocardial infarction, angina, or silent myocardial ischemia verified by invasive testing
We did not find any association of Carotid atherosclerosis (CA) and carotid artery stenosis (CAS) with HbA1c levels, we identified increased mean amplitude of glycemic excursions (MAGE) (≥3.38 mmol/L)—an indicator of glucose variability—as a risk factor
Summary
Cardiovascular diseases are the leading cause of death globally. According to theWorld Health Organization, 17.9 million people died from cardiovascular diseases (CVDs) in 2019, representing 32% of all global deaths; most of these deaths were due to heart attack and stroke [1]. Cardiovascular diseases are the leading cause of death globally. World Health Organization, 17.9 million people died from cardiovascular diseases (CVDs) in 2019, representing 32% of all global deaths; most of these deaths were due to heart attack and stroke [1]. Elaboration of predictive models of cardiovascular diseases remains a priority for clinical medicine. A number of epidemiological studies have revealed increased carotid intima–media thickness (CIMT) as a risk factor for myocardial infarction and stroke [2]. Identification of carotid plaques, compared with CIMT, further increases predictive accuracy for myocardial infarction [3]. Extracranial internal carotid artery stenosis (CAS) is a major cause of ischemic stroke, and it is estimated to cause 8–15%
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