Abstract
BackgroundIntima-media thickness (IMT) of the common carotid artery is a surrogate end point of cardiovascular disease (CVD). Identifying the factors associated with a higher IMT may contribute to the identification of subjects with higher CVD risk. Our objective was to compare the common carotid IMT of type 1 diabetes patients to healthy control subjects. The secondary objective was to determine factors associated with a higher carotid IMT.MethodsWe conducted a cross-sectional study between March 2009 and October 2013, comprising 127 type 1 diabetes patients and 125 control subjects matched by age, gender and body mass index (BMI). Carotid IMT was measured using semi-automated edge detection software.ResultsType 1 diabetes patients had a higher median IMT compared with control subjects (0.538; IQR: 0.500-0.607 vs 0.513 mm; IQR: 0.481-0.557, respectively p = 0.001). Women with type 1 diabetes had a higher median IMT difference compared to the control group (0.537; IQR: 0.495-0.596 vs 0.502 mm; IQR: 0.472-0.543, respectively p = 0.003) than did men with type 1 diabetes (0.547; IQR: 0.504-0.613 vs 0.528 mm; IQR: 0.492-0.575, respectively p = 0.2). Age and diabetes duration had an additive effect on the IMT of type 1 diabetes patients. Multivariate gamma regression model analysis showed that in type 1 diabetes patients, the IMT was associated with age (Exp (β) = 1.006, p < 0.001), duration of diabetes (Exp (β) = 1.004, p = 0.001), BMI (Exp (β) = 1.005, p = 0.021), family history of type 2 diabetes (Exp (β) = 1.044, p = 0.033), total cholesterol (Exp (β) = 0.999, p = 0.001) and creatinine clearance (Exp (β) = 1.000, p = 0.043).ConclusionsPatients with type 1 diabetes have increased IMT, a marker of subclinical atherosclerosis. The CVD risk may be similar between men and women with type 1 diabetes, suggesting a loss of gender protection. Also, CVD risk may be higher in those with a family history of type 2 diabetes. Prospective studies are needed to confirm the predictive value of these findings and the causal effect between IMT and CVD in patients with type 1 diabetes.
Highlights
Intima-media thickness (IMT) of the common carotid artery is a surrogate end point of cardiovascular disease (CVD)
Type 1 diabetes patients are continuously exposed to a hyperglycemic environment and other CVD risk factors, such as insulin dosage and the presence of chronic complications [16]
One study showed that the soluble form of the membrane glycoprotein CD146 derived from endothelium cells is increased in individuals with cardiovascular and inflammatory disease and is associated with endothelial dysfunction [17]
Summary
Intima-media thickness (IMT) of the common carotid artery is a surrogate end point of cardiovascular disease (CVD). The cardiovascular disease (CVD) risk in type 1 diabetes is approximately 10 times higher than that in the general population, even in the absence of classical risk factors and adequate metabolic control [6,7,8,9,10,11,12,13,14,15]. Type 1 diabetes patients are continuously exposed to a hyperglycemic environment and other CVD risk factors, such as insulin dosage and the presence of chronic complications [16]. All of these risk factors are present at a very young age, resulting in progressive endothelial dysfunction that results in the atherosclerosis process [12,14,15]. Some other unknown CVD risk factors might be present as there is still a residual CVD risk even in patients with excellent metabolic control [16]
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