CORRELATION BETWEEN CAROTID INTIMA-MEDIA THICKNESS WITH URINE ALBUMIN CREATININE RATIO IN PATIENTS WITH TYPE 2 DABETES MELLITUS

Abstract

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality for individuals with diabetes. Common conditions coexisting with type 2 diabetes (e.g., hypertension and dyslipidemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. Large benets are seen when multiple cardiovascular risk factors are addressed simultaneously. Increased urinary albumin excretion (albuminuria) and reduced Glomerular Filtration Rate (GFR) are risk factors for progressive kidney failure and cardiovascular disease. It has been reported that microalbuminuria had a close association with cardiovascular diseases (CVD) as well. It was also reported that microalbuminuria or macroalbuminuria increased the mortality rate by 60 – 80% (1) . Albuminuria can be most easily performed by urinary albumin-to Creatinine ratio (ACR) in a random spot urine collection (2). Atherosclerosis is the main cause of cardiovascular diseases; measurement of IMT (Intima Media Thickness) enables the detection of atherosclerosis lesions of the arterial wall. CIMT (Carotid Intima Media Thickness) can be measured by high frequency B mode ultrasonography, which provides a high degree of accuracy in estimating the arterial wall thickness. B-mode gray scale sonography allows for imaging of atherosclerotic plaques and intima-media thickness of carotid arteries. Of these, continuous- wave Doppler and single-gate pulsed-wave Doppler sonography incorporated in duplex systems are reported to be highly accurate relative to angiography for the detection and classication of the degree of obstruction producing a narrowing of lumen more than 50%. In addition, the use of high-resolution B-mode real-time sonography makes it possible to identify small, non stenotic (<50%) plaques and to describe the echo morphology of carotid arteries (3). The carotid IMT is signicantly higher in diabetic patients than that in non-diabetic patients (4), and the increased IMT can predict future events of silent brain infarction and coronary heart disease in the patients with T2DM (5). Carotid IMT is considered to reect an early stage of macroangiopathy in patients with diabetes. An increasing CIMT above normal level (> 0.8 mm) is associated with increasingly severe coronary artery disease, an increased risk of myocardial infarction and also stroke. Urine ACR is an important marker for the progression of renal dysfunction and is currently recognized as predictive factors for CVD. However, association of IMT with both urinary ACR (Albumin Creatinine Ratio) in type 2 diabetic patients has been investigated in a few reports. Keeping them in mind, a hospital based cross sectional study was performed on the patients presenting with type 2 diabetes mellitus. The study was aimed to establish the role of urine ACR as a leading investigation in patients presenting with type 2 diabetes mellitus for cardiovascular risk assessment. It was intended to evaluate the Carotid IMT in these patients and also detection of atherosclerotic plaque which are clearly related to pathogenesis and aid in planning of management. Our objective is to nd out the correlation between urine ACR and carotid intima media thickness (CIMT) in type 2 diabetes patients and whether urine ACR can be used as a screening tool for risk stratication for future cardiovascular disease in Indian population.