Abstract
BackgroundAlthough diabetic patients have an increased rate of cardio-vascular events, there is considerable heterogeneity with respect to cardiovascular risk, requiring new approaches to individual cardiovascular risk factor assessment. In this study we used whole body-MR-angiography (WB-MRA) to assess the degree of atherosclerosis in patients with long-standing diabetes and to determine the association between metabolic syndrome (MetS) and atherosclerotic burden.MethodsLong standing (≥10 years) type 1 and type 2 diabetic patients (n = 59; 31 males; 63.3 ± 1.7 years) were examined by WB-MRA. Based on the findings in each vessel, we developed an overall score representing the patient's vascular atherosclerotic burden (MRI-score). The score's association with components of the MetS was assessed.ResultsThe median MRI-score was 1.18 [range: 1.00-2.41] and MetS was present in 58% of the cohort (type 2 diabetics: 73%; type 1 diabetics: 26%). Age (p = 0.0002), HDL-cholesterol (p = 0.016), hypertension (p = 0.0008), nephropathy (p = 0.0093), CHD (p = 0.001) and MetS (p = 0.0011) were significantly associated with the score. Adjusted for age and sex, the score was significantly (p = 0.02) higher in diabetics with MetS (1.450 [1.328-1.572]) compared to those without MetS (1.108 [0.966-1.50]). The number of MetS components was associated with a linear increase in the MRI-score (increase in score: 0.09/MetS component; r2 = 0.24, p = 0.038). Finally, using an established risk algorithm, we found a significant association between MRI-score and 10-year risk for CHD, fatal CHD and stroke.ConclusionIn this high-risk diabetic population, WB-MRA revealed large heterogeneity in the degree of systemic atherosclerosis. Presence and number of traits of the MetS are associated with the extent of atherosclerotic burden. These results support the perspective that diabetic patients are a heterogeneous population with increased but varying prevalence of atherosclerosis and risk.
Highlights
Today diabetes mellitus is often classified as a coronary heart disease (CHD) equivalent [1], which has significantly influenced the guidelines for the treatment of diabetic complications over the last couple of years [2]
While the joint statement from the American Diabetes Association and the European Association for the Study of Diabetes (EASD) stated that the term metabolic syndrome (MetS) should not be used as a diagnosis and that diabetes should be excluded from the definition of the MetS since the presence of a MetS seems to provide no additional predictive value for cardiovascular complications or therapeutic consequences in patients with diabetes [8], other still find the MetS useful for clinical purposes [17,18,19,20]
We developed a score based on the whole body-MR-angiography (WB-MRA) findings representing the atherosclerotic burden of each patient
Summary
Today diabetes mellitus is often classified as a coronary heart disease (CHD) equivalent [1], which has significantly influenced the guidelines for the treatment of diabetic complications over the last couple of years [2]. While the joint statement from the American Diabetes Association and the European Association for the Study of Diabetes (EASD) stated that the term MetS should not be used as a diagnosis and that diabetes should be excluded from the definition of the MetS since the presence of a MetS seems to provide no additional predictive value for cardiovascular complications or therapeutic consequences in patients with diabetes [8], other still find the MetS useful for clinical purposes [17,18,19,20]. We have used whole-body magnetic resonance angiography (WB-MRA) in patients with long-standing type 1 or type 2 diabetes to obtain comprehensive vascular imaging (except coronaries) [21]. What is the variation of atherosclerotic burden in patients with long-standing diabetes? In this study we used whole body-MR-angiography (WB-MRA) to assess the degree of atherosclerosis in patients with long-standing diabetes and to determine the association between metabolic syndrome (MetS) and atherosclerotic burden
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