Intima-media Thickness In Type Research Articles

Ultrasonic Measurement of Common Carotid Intima-Media Thickness in Type 2 Diabetic and Non-Diabetic Patients

BackgroundDiabetes mellitus is a widespread disease. Its vascular complications can be characterized by arteriosclerosis formation in carotid arteries. Due to its delayed diagnosis resulting in more complications in Iran, it seems that screening diabetic patients is mandatory.ObjectivesThe aim of this study was to compare the intima-media thickness (IMT) of carotid artery in diabetic and non-diabetic patients.Patients and MethodsThis is a cross-sectional study, which included 80 participants (40 diabetics and 40 non-diabetics). By using ultrasound, bilateral IMTs of the distal carotid were measured and the data were analyzed using ANOVA and multivariate regression tests in SPSS 14.ResultsThe mean IMT was 0.97 in diabetic patients and 0.63 in non-diabetics (P < 0.001). Age and gender had significant positive effects on the increase of IMT (P < 0.05 and P < 0.005, respectively for age and gender). Past medical history of coronary heart disease (CHD) and cerebrovascular accident (CVA) in diabetes is associated significantly with an increase in IMT (P =0.019 and 0.027 respectively). Other confounding variables such as smoking, history of hypertension (HTN) and hyperlipoproteinemia (HLP) in diabetic patients showed no significant relationship with the increase of IMT.ConclusionsAlthough measuring the IMT of the carotid artery by sonography is a useful tool for screening diabetic patients, more studies are needed for determining how to use these measurements in promoting the patients outcomes.

Cardiovascular disease in recent onset diabetes mellitus

Diabetes is associated with a marked increased risk of atherosclerotic vascular disorders, including coronary, cerebrovascular, and peripheral artery disease. Cardiovascular disease (CVD) could account for disabilities and high mortality rates in patients with diabetes. Conventional risk factors, including hyperlipidemia, hypertension, smoking, obesity, lack of exercise, and a positive family history, contribute similarly to macrovascular complications in type 2 diabetic patients and non-diabetic subjects. The levels of these factors in diabetic patients are certainly increased, but not enough to explain the exaggerated risk for macrovascular complications in the diabetic population. Furthermore, recently, macrovascular complications of diabetes have been shown to start before the onset of diabetes. Indeed, several clinical studies have confirmed the increased risk of CVD in patients with impaired glucose tolerance (IGT). Since insulin resistance-related postprandial metabolic derangements are thought to play a central role in the development and progression of CVD in patients with IGT, amelioration of postprandial metabolic disturbance is a therapeutic target for the prevention of CVD in these high-risk patients. Therefore, in this paper, we review the molecular mechanisms for the increased risk of CVD in recent onset diabetes mellitus, especially focusing on postprandial dysmetabolism. We also discuss here the potential therapeutic strategies that specially target the mechanisms responsible for vascular alterations in diabetes.

Associations of intra-renal arterial resistance index with chronic kidney disease and carotid intima-media thickness in type 2 diabetes mellitus

Renal dysfunction can be evaluated by increased intra-renal arterial resistance index (RI). We evaluated 113 Chinese men with type 2 diabetes on their RI. Results suggest that RI is associated with chronic kidney disease and subclinical arteriosclerosis. RI may help monitoring the deterioration of intra-renal hemodynamics.

Levels of Oxidized LDL and Advanced Glycation End Products–Modified LDL in Circulating Immune Complexes Are Strongly Associated With Increased Levels of Carotid Intima-Media Thickness and Its Progression in Type 1 Diabetes

OBJECTIVEHigh cholesterol levels in circulating immune complexes (IC), surrogate markers of modified LDL, are associated with increased carotid intima-media thickness (IMT) and cardiovascular events in type 1 diabetes. Different modifications of LDL are involved in IC formation, but which of these are predictive of vascular events is not known. Therefore, we measured oxidized LDL (oxLDL), advanced glycation end products–modified LDL (AGE-LDL), and malondialdehyde-modified LDL (MDA-LDL) in IC and determined their relationship with increased carotid IMT and compared the strength of the association with that observed with conventional risk factors.RESEARCH DESIGN AND METHODSLevels of oxLDL, AGE-LDL, and MDA-LDL were measured in circulating IC isolated from sera of 479 patients of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort, collected at baseline. Internal and common carotid IMT were measured 8 and 14 years later by DCCT/EDIC.RESULTSOxLDL, AGE-LDL, and MDA-LDL levels in circulating IC were significantly correlated with diabetes duration, BMI, and lipid and blood pressure, but not with age. Multivariate logistic regression models indicated that individuals in the highest versus lowest quartile of oxLDL and AGE-LDL in IC had a 6.11-fold [confidence interval (CI) 2.51–14.8] and a 6.4-fold (CI 2.53–16.2) increase in the odds of having high carotid IMT, respectively, after adjusting for conventional risk factors. Parallel analyses resulted in odds ratios of 2.62 (CI 1.24, 5.55) for LDL-C, 1.45 (CI 0.69, 3.03) for diastolic blood pressure, and 2.33 (CI 1.09, 4.99) for A1C.CONCLUSIONSOxLDL and AGE-LDL in circulating IC were significantly associated with progression and increased levels of carotid IMT in type 1 diabetes.

Elevated serum retinol-binding protein 4 concentrations are associated with chronic kidney disease but not with the higher carotid intima-media thickness in type 2 diabetic subjects

To examine the association of serum retinol-binding protein 4 (RBP4) concentrations with carotid intima-media thickness (CIMT) in type 2 diabetic subjects with chronic kidney disease (CKD). A total of 239 type 2 diabetic patients (64 ± 13 years, 154 males) were divided into two groups: one with CKD, defined as estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73m(2) (n = 86), and one without (n = 153). We recorded clinical and biochemical data as well as CIMT. The patients with CKD were older, had had diabetes mellitus longer, and had higher incidence of hypertension, dyslipidemia and microalbuminuria than those without. They also had higher serum concentrations of RBP4 (44.8 ± 6.4 vs 39.5 ± 4.9 µg/mL, p < 0.001), higher mean CIMT (0.75 ± 0.16 vs 0.69 ± 0.14 mm, p = 0.0070), and higher incidence of carotid plaques (27.9 vs 11.8 %, p = 0.002). The RBP4 were negatively correlated with eGFR (r = -0.514, p < 0.001). However, the RBP4 were not correlated with mean CIMT (r = 0.065, p = 0.318). Moreover, when dividing the patients into two groups by the mean CIMT, those with mean CIMT above 0.71 mm did not have different RBP4 concentrations compared with those below (41.5 ± 5.7 vs 41.3 ± 6.3 µg/mL, p = 0.856). In conclusion, we observed an elevation of serum RBP4 concentrations and CIMT levels in type 2 diabetic subjects with CKD. However, the elevated RBP4 were not associated with the higher CIMT among these patients.

Post-challenge hyperglycaemia, nitric oxide production and endothelial dysfunction: The putative role of asymmetric dimethylarginine (ADMA)

The endothelium is a thin layer of cells at the internal surface of blood vessels in continuous contact with the circulating fluids. The endothelial cells represent the primary barrier for the transport of glucose from the vascular conduits into the interstitial space. Insulin and nitric oxide have an important role in the regulation of glucose transport and metabolism. Hyperglycaemia is the main criteria for the diagnosis of diabetes and is responsible for the micro- and macro-vascular pathology seen in diabetic patients. Recent evidence suggests that post-challenge hyperglycaemia is a better predictor of cardiovascular risk than fasting glucose. Acute glucose elevations have been associated with a reduced endothelial-dependent flow mediated dilation indicating a decrease in nitric oxide production. Post-prandial hyperglycaemic peaks have been directly associated with increased intima media thickness in type 2 diabetic patients indicative of an increased atherosclerotic risk. The increase in intra-cellular glucose concentrations in the endothelial cells induces a hyper-generation of reactive oxygen species via the activation of different pathways (polyol-sorbitol, hexosamine, advanced glycated end products, activation of PKC, asymmetric dimethylarginine (ADMA)). These mechanisms influence the expression of genes and release of signalling and structural molecules involved in several functions (inflammation, angiogenesis, coagulation, vascular tone and permeability, cellular migration, nutrient metabolism). ADMA is considered as a biomarker of endothelial dysfunction and it has been associated with an increased risk of atherosclerosis and cardiovascular diseases. The increased generation of ADMA and reactive oxygen species in subjects with persistent hyperglycaemia could lead to an impairment of nitric oxide synthesis.

Efficacy of pioglitazone on glycemic control and carotid intima-media thickness in type 2 diabetes patients with inadequate insulin therapy.

Aims/Introduction: The present study was designed to determine the effects of pioglitazone on glycemic control and atherosclerosis in patients with poorly controlled type 2 diabetes on insulin therapy. The study was a prospective, randomized controlled trial involving 48 patients with inadequately controlled type 2 diabetes treated with insulin. We assigned patients to oral pioglitazone titrated from 15-30 mg (n = 22) or no pioglitazone (n = 26), to be taken in addition to their glucose-lowering drugs and other medications. Daily insulin doses and numbers were recorded during the study period. The adjusted mean glycosylated hemoglobin (HbA1c) values decreased significantly by 1.13 ± 1.50% and 0.55 ± 0.76% in the pioglitazone and control groups, respectively. Significant decrease of HbA1c level was observed in the pioglitazone group compared with the control group (P < 0.05). The insulin dose lowered by 0.04 ± 0.10 units/kg/day in the pioglitazone group and increased by 0.03 ± 0.10 units/kg/day in the control group (P < 0.05). The number of insulin injections decreased by 0.1 ± 0.6 times/day in the pioglitazone group and increased by 0.2 ± 0.4 times/day in the control group (P < 0.05). The carotid intima-media thickness estimated by B-mode echography was carried out in both groups and decreased significantly at the end-point only in the pioglitazone group, relative to the baseline. These findings show that pioglitazone is useful in improving glycemic control and preventing the progression of atherosclerosis in poorly-controlled type 2 diabetics on insulin therapy. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2010.00064.x, 2010).

Correlation between glucose fluctuations and carotid intima-media thickness in type 2 diabetes

Aims To evaluate the relationship between blood glucose fluctuations and carotid atherosclerosis (AS) in type 2 diabetic patients. Methods A case-control study included 36 patients with type 2 diabetes and 10 controls. According to the levels of carotid intima-media thickness (CIMT), 36 diabetic patients were classified into two groups, the diabetes mellitus without atherosclerosis (DM − AS, n = 20) and diabetes mellitus with atherosclerosis (DM + AS, n = 16). The glucose excursions were assessed by the following parameters obtained from continuous glucose monitoring system for 72 h: the mean blood glucose (MBG) and its standard deviation (SD), the area under the ROC curve when the blood glucose was higher than 7.8 mmol/L (AUC7.8), the mean amplitude of glycemic excursion (MAGE), the mean of daily differences (MODD), and the largest amplitude of glycemic excursion (LAGE). Results The levels of MBG, SD, MAGE, LAGE, and AUC7.8 were gradually increased with the progression of atherosclerosis ( P < 0.05). The Spearman's correlation analysis showed that the CIMT was correlated to the age ( R = 0.58, P < 0.001), the duration ( R = 0.50, P < 0.001), the MAGE ( R = 0.34, P = 0.021), and the LAGE ( R = 0.31, P = 0.035). Conclusion These results suggest that glucose fluctuations may accelerate atherogenesis in older type 2 diabetic patients who had a longer duration.

Lipoprotein(a) predicts progression of carotid artery intima-media thickening in patients with type 2 diabetes: A four-year follow-up

The aim of the study was to establish whether increased levels of serum lipoprotein(a) significantly contribute to an increase in intima-media thickness and the number of carotid artery plaques, and consequently to cardiovascular risk in patients with type 2 diabetes mellitus. Lipoprotein(a) levels, intima-media thickness and the number of carotid artery plaques were determined at the beginning of the study in 146 patients with type 2 diabetes. Patients were divided into two groups according to serum lipoprotein(a) levels (> or <or=30 mg/dl). Intima-media thickness and the number of plaques were again determined after four years of follow-up. Intima-media thickness was assessed using high-resolution B-mode ultrasound. The two groups of patients revealed no significant differences in baseline intima-media thickness (P = 0.112) in relation to lipoprotein(a) level. After follow-up, intima-media thickness was significantly greater in patients with higher lipoprotein(a) levels (1.24 + 0.22 vs. 1.15 + 0.17 mm, respectively; P = 0.005). The mean increase in thickness over four years was 0.12 mm (0.030 mm/year) in the group with low lipoprotein(a) levels and 0.17 mm (0.043 mm/year) in the group with high lipoprotein(a). Multivariate analysis indicated that intima-media thickness depended on lipoprotein(a), and not on triglyceride, HDL-cholesterol levels or waist-to-hip ratio. No significant difference in baseline and follow-up number of plaques was observed between the study groups (P = 0.276 vs. P = 0.355, respectively). Although the group with lipoprotein(a) >30 mg/dl had more cardiovascular events, the difference was not statistically significant. These results indicate that lipoprotein(a) is an independent, genetically determined risk factor closely associated with progression of intima-media thickness in type 2 diabetes.

Nonalcoholic Fatty Liver Is Not Associated with Carotid Intima-Media Thickness in Type 2 Diabetic Patients

Nonalcoholic fatty liver disease (NAFLD) is commonly associated with obesity, metabolic syndrome, and type 2 diabetes. Several studies suggest that NAFLD is independently associated with an increased risk of cardiovascular disease in nondiabetic subjects. In type 2 diabetic subjects, the link between fatty liver and atherosclerosis is less clear. In this study, we set out to determine, whether fatty liver content, evaluated using 1H-magnetic resonance spectroscopy, a very precise imaging technique, was associated with atherosclerosis in people with type 2 diabetes. A total of 101 patients with type 2 diabetes mellitus were included in this study. Liver fat (1H-magnetic resonance spectroscopy) and carotid intima media thickness (IMT) were measured. Sixty-one (60.3%) patients had steatosis (hepatic triglyceride content greater than 5.5%). Liver fat content was correlated with fasting serum triglycerides (r = 0.22; P = 0.02) and alanine aminotransferase (r = 0.42; P = 0.0001). Sixty-eight percent of subjects with severe steatosis (hepatic triglyceride content greater than 15%) had aspartate aminotransferase in the normal range. Age was strongly correlated with IMT (r = 0.37; P = 0.0002). Steatosis did not correlate with IMT (r = -0.03; P = 0.75). There was no significant difference between the two groups (with and without hepatic steatosis) for IMT values. this study suggests that in people with type 2 diabetes, fatty liver is not associated with cardiovascular disease. In a diabetic population, it seems that fatty liver is not a determinant factor associated with carotid IMT.

Increased mean carotid intima media thickness in type 2 diabetes mellitus patients with non-blood pressure component metabolic syndrome: A preliminary report

AIMS:Patients with type-2 diabetes mellitus have greater carotid intima media thickness and they are at risk for generalized atherosclerosis. This study aimed to compare the thickness of carotid artery intima media in type-2 diabetes mellitus patients with and without nonblood pressure component metabolic syndrome.SETTINGS AND DESIGN:This was a comparative observational study conducted in the Departments of Pharmacology and Physiology in the College of Medicine, Al-Mustansiriyia University in cooperation with Baghdad Teaching Hospital.MATERIALS AND METHODS:Forty-six diabetic patients of both sexes with systolic blood pressure < 130 mm Hg and diastolic blood pressure < 85 mm Hg were subjected to high resolution B-mode ultrasonography of the common and internal carotid arteries. Patients were grouped into those without metabolic syndrome (Group I) and with nonblood pressure component metabolic syndrome (Group II).STATISTICAL ANALYSIS:The two-tailed unpaired Student's t-test was used in this study.RESULTS:Significantly high mean thickness was observed in the common carotid intima media (0.824 ± 0.155 mm) but not in the internal carotid arteries in group II patients compared to group I patients (0.708 ± 0.113 mm). Group II also had a significant number of patients with increased lesion intima media thickness (≥ 1.1 mm).Conclusion:The greater carotid intima media thickness observed in type 2 diabetes mellitus patients is related to the metabolic syndrome even in the absence of the blood pressure component.

Serum endogenous secretory RAGE level is an independent risk factor for the progression of carotid atherosclerosis in type 1 diabetes

Objective Advanced glycation end-products (AGEs) and the receptor for AGEs (RAGE) system plays an important role in the development of atherosclerosis. It has been recently reported that endogenous secretory RAGE (esRAGE) and total soluble RAGE (sRAGE) levels are associated with diabetic complications. The aim of the present study is to longitudinally evaluate the association between esRAGE and sRAGE levels and the progression of carotid intima-media thickness (IMT), a surrogate marker of atherosclerosis. Methods and results Japanese type 1 diabetic patients ( n = 47, aged 24.0 ± 3.1 years) were enrolled into a 4-year follow-up study and annual measurements of serum esRAGE and sRAGE levels and IMTs were performed. At baseline, mean-IMT was inversely correlated with circulating esRAGE levels ( r = −0.317, p = 0.0292), whereas there was not statistical significance between mean-IMT and sRAGE levels. Mean-IMT significantly increased during the follow-up period (from 0.63 ± 0.10 to 0.67 ± 0.10 mm, p = 0.0022). Annual increase in mean-IMT (=(mean-IMT after 4 years − mean-IMT at baseline)/4) was positively correlated with the arithmetic average of systolic blood pressure ( r = 0.310, p = 0.0332) and triglyceride ( r = 0.337, p = 0.0201), and inversely correlated with circulating esRAGE levels ( r = −0.360, p = 0.0124) and sRAGE levels ( r = −0.406, p = 0.0042) during the follow-up period. Furthermore, stepwise multivariate regression analyses revealed that continuous low levels of circulating esRAGE and sRAGE were determinants of the progression of mean-IMT independently of conventional risk factors. Conclusions Circulating esRAGE level as well as sRAGE level was an independent risk factor for the progression of carotid IMT in type 1 diabetic subjects.

Phospholipid transfer protein deficiency ameliorates diet-induced hypercholesterolemia and inflammation in mice

Phospholipid transfer protein (PLTP) facilitates the transfer of phospholipids from triglyceride-rich lipoproteins into HDL. PLTP has been shown to be an important factor in lipoprotein metabolism and atherogenesis. Here, we report that chronic high-fat, high-cholesterol diet feeding markedly increased plasma cholesterol levels in C57BL/6 mice. PLTP deficiency attenuated diet-induced hypercholesterolemia by dramatically reducing apolipoprotein E-rich lipoproteins (-88%) and, to a lesser extent, LDL (-40%) and HDL (-35%). Increased biliary cholesterol secretion, indicated by increased hepatic ABCG5/ABCG8 gene expression, and decreased intestinal cholesterol absorption may contribute to the lower plasma cholesterol in PLTP-deficient mice. The expression of proinflammatory genes (intercellular adhesion molecule-1 and vascular cell adhesion molecule-1) is reduced in aorta of PLTP knockout mice compared with wild-type mice fed either a chow or a high-cholesterol diet. Furthermore, plasma interleukin-6 levels are significantly lower in PLTP-deficient mice, indicating reduced systemic inflammation. These data suggest that PLTP appears to play a proatherogenic role in diet-induced hyperlipidemic mice.

Post-Meal Glucose Peaks at Home Associate with Carotid Intima-Media Thickness in Type 2 Diabetes

Two-hour postprandial hyperglycemia is related to chronic complications of diabetes and is currently used in the international guidelines to drive the therapy. Our objective was to assess the size and timing of post-meal glucose peaks in the everyday life of type 2 diabetic patients and the relationship with carotid atherosclerosis. This was an observational study performed in 644 outpatients with type 2 diabetes attending diabetes clinics located in the area of the Campania County, South Italy, who provided complete home blood glucose profiles and centralized carotid intima-media thickness (CIMT) assessment. The study was conducted from 2001-2005. Incremental glucose peak (IGP) was the maximal incremental increase in blood glucose obtained at any point after the meal. CIMT was assessed by carotid sonography. The level of glycosylated hemoglobin and CIMT progressively increased across quintiles of IGP (P for trend = 0.01 for both). In univariate analysis, all examined glycemic parameters were significantly correlated with CIMT. IGP (r = 0.40; P = 0.006) showed the strongest correlation with CIMT, which remained significant in multiple linear regression analysis (R(2) = 0.26; P = 0.01). IGP was associated with a significant increase of CIMT in tertiles of glycosylated hemoglobin. IGP occurred within 1 h from the start of the meal in 95% of the entire diabetic population. IGPs are frequent in the everyday life of patients with type 2 diabetes, occur for most (95%) within 1 h after meal, timing of IGPs is not influenced by treatment (diet or drugs), and IGPs correlate with CIMT.

The Limitation in Measurement of Carotid Intima Media Thickness in Type 2 Diabetics with or without Coronary Artery Disease

The Limitation in Measurement of Carotid Intima Media Thickness in Type 2 Diabetics with or without Coronary Artery Disease

Effect of Acarbose, an Alpha-Glucosidase Inhibitor, on Serum Lipoprotein Lipase Mass Levels and Common Carotid Artery Intima-Media Thickness in Type 2 Diabetes Mellitus Treated by Sulfonylurea

Previous reports indicate that serum lipoprotein lipase mass levels (LPL mass) and common carotid artery intima-media thickness (CCA-IMT) are independent predictors of atherosclerotic diseases. The aim of this study was to examine the effects of combination therapy of sulfonylurea and acarbose on LPL mass and CCA-IMT. Eighty-four patients with type 2 diabetes mellitus, who were treated with only sulfonylureas and showed CCA-IMT of more than 0.9 mm at baseline, were selected and randomly divided into two groups. One group was administered acarbose 300 mg/day for 12 months (acarbose group, n=41), and the other group was not administered acarbose (non-acarbose group, n=43). After 12 months, a significant increase in LPL mass and a significant decrease in CCA-IMT were observed in the acarbose group (1.024 to 0.964 mm), but no significant changes were observed in the non-acarbose group. In a subgroup analysis of patients with HbA1c improved by 0.5% or more, the increase of LPL mass and decrease of CCA-IMT was significantly greater in the acarbose group than in the non-acarbose group although the changes in HbA1c were similar in two groups. We concluded that reducing postprandial hyperglycemia might increase LPL mass levels and might be useful to prevent macroangiopathy in type 2 diabetic patients treated by sulfonylurea.

Nateglinide Reduces Carotid Intima-Media Thickening in Type 2 Diabetic Patients Under Good Glycemic Control

Postprandial hyperglycemia observed in type 2 diabetes mellitus is a risk factor for atherosclerosis. The aim of this study was to investigate the effect of strict glycemic control by nateglinide on common carotid far wall intima-media thickness in type 2 diabetic patients who were already under good glycemic control. We performed an open labeled randomized prospective trial on 78 drug-naive type 2 diabetic patients whose HbA1c was less than 6.5%. Thirty-eight patients were randomly assigned to receive nateglinide (270 mg/dL) and 40 to control group (no treatment). After 12 months, a significant reduction in HbA1c was observed in the nateglinide group, whereas a significant increase of HbA1c was observed in the untreated group. The carotid intima-media thickness at the end of 1-year follow-up was significantly reduced in the nateglinide group compared with the untreated group (-0.017+/-0.054 mm/year versus 0.024+/-0.066 mm/year, P=0.0064). Whereas nateglinide treatment also reduced triglyceride, highly-sensitive C-reactive protein, and E-selectin, multiple regression analysis identified HbA1c as the only significant independent determinant of the change in carotid intima-media thickness. In type 2 diabetic patients with good glycemic control, further strict glycemic control by nateglinide results in regression of carotid intima-media thickness.

The effects of pioglitazone on cerebrovascular resistance in patients with type 2 diabetes mellitus

Atherosclerosis is one of the major causes of morbidity and mortality in patients with type 2 diabetes mellitus. Pioglitazone has been reported to have antiatherogenic effects. The aim of this study was to investigate whether pioglitazone affects pulsatility index (PI) of the cerebral arteries and the carotid intima-media thickness in type 2 diabetic patients. A total of 40 type 2 diabetic patients were included in this study. They were divided into 2 groups: the pioglitazone-treated group (pioglitazone 15 mg/d with gliclazide 80-320 mg/d for 12 weeks) and the gliclazide-treated group (gliclazide 80-320 mg/d for 12 weeks). Transcranial Doppler ultrasonography was performed for each cerebral artery, and PI was calculated as (systolic velocity − diastolic velocity)/mean velocity. The pioglitazone treatment significantly increased high-density lipoprotein cholesterol and decreased triglyceride levels and insulin resistance. This study revealed that the change in mean intima-media thickness was not significant in both groups, but the change in PI was significantly decreased with pioglitazone compared to gliclazide. In conclusion, pioglitazone decreased PI and improved cerebrovascular resistance in type 2 diabetic patients.

Effect of Pioglitazone Compared with Glimepiride on Carotid Intima-media Thickness in Type 2 Diabetes

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Lower plasma adiponectin is a marker of increased intima-media thickness associated with type 2 diabetes mellitus and with male gender

We tested the extent to which altered plasma adipokine levels may contribute to the increased carotid artery intima-media thickness (IMT) associated with type 2 diabetes mellitus and with male gender, independently of conventional cardiovascular risk factors, insulin resistance, and plasma C-reactive protein (CRP). IMT (mean of three segments of both carotid arteries by ultrasonography), insulin resistance (homeostasis model assessment; HOMA(ir)), plasma CRP, lipids, adiponectin, leptin, resistin, and tumor necrosis factor-alpha (TNF-alpha) were measured in 84 type 2 diabetic patients and 85 control subjects. In diabetic patients, IMT (P<0.001), mean arterial pressure (P<0.001), HOMA(ir) (P<0.001), plasma CRP (P=0.003), triglycerides (P=0.037), leptin (P=0.023), resistin (P=0.003), and TNF-alpha (P=0.003) levels were higher, whereas high-density lipoproteins (HDL) cholesterol (P<0.001) and adiponectin (P<0.001) levels were lower compared with control subjects. Plasma adiponectin (P<0.001) and leptin (P<0.001) were substantially lower in men than in women. IMT was positively and independently associated with age (P<0.001), diabetes (P=0.049), and male gender (P=0.002) in a multivariate regression model, not including other variables. Further analyses showed that IMT was positively related to age (P<0.001) and plasma triglycerides (P=0.038) and negatively to adiponectin (P<0.001), without independent effects of diabetes, gender, and HOMA(ir). Increased IMT in type 2 diabetes may in part be explained by lower plasma adiponectin and higher triglycerides, but not by leptin, resistin, and TNF-alpha. The gender effect on IMT is related to lower plasma adiponectin.