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Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study

Shore, A. C.; Colhoun, H. M.; Natali, A.; Palombo, C.; Östling, Gerd LU ; Aizawa, K.; Kennback, C.; Casanova, F.; Persson, Margaretha LU and Gooding, K., et al. (2015) In Journal of Internal Medicine 278(3). p.291-302
Abstract
BackgroundThere is a need to develop and validate surrogate markers of cardiovascular disease (CVD) in subjects with diabetes. The macrovascular changes associated with diabetes include aggravated atherosclerosis, increased arterial stiffness and endothelial dysfunction. The aim of this study was to determine which of these factors is most strongly associated with clinically manifest cardiovascular events. MethodsVascular changes were measured in a cohort of 458 subjects with type 2 diabetes (T2D) and CVD (myocardial infarction, stroke or lower extremity arterial disease), 527 subjects with T2D but without clinically manifest CVD and 515 subjects without T2D and with or without CVD. ResultsCarotid intima-media thickness (IMT) and... (More)
BackgroundThere is a need to develop and validate surrogate markers of cardiovascular disease (CVD) in subjects with diabetes. The macrovascular changes associated with diabetes include aggravated atherosclerosis, increased arterial stiffness and endothelial dysfunction. The aim of this study was to determine which of these factors is most strongly associated with clinically manifest cardiovascular events. MethodsVascular changes were measured in a cohort of 458 subjects with type 2 diabetes (T2D) and CVD (myocardial infarction, stroke or lower extremity arterial disease), 527 subjects with T2D but without clinically manifest CVD and 515 subjects without T2D and with or without CVD. ResultsCarotid intima-media thickness (IMT) and ankle-brachial pressure index were independently associated with the presence of CVD in subjects with T2D, whereas pulse wave velocity and endothelial function provided limited independent additive information. Measurement of IMT in the carotid bulb provided better discrimination of the presence of CVD in subjects with T2D than measurement of IMT in the common carotid artery. The factors most significantly associated with increased carotid IMT in T2D were age, disease duration, systolic blood pressure, impaired renal function and increased arterial stiffness, whereas there were no or weak independent associations with metabolic factors and endothelial dysfunction. ConclusionsMeasures of atherosclerotic burden are associated with clinically manifest CVD in subjects with T2D. In addition, vascular changes that are not directly related to known metabolic risk factors are important in the development of both atherosclerosis and CVD in T2D. A better understanding of the mechanisms involved is crucial for enabling better identification of CVD risk in T2D. (Less)
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publication status
published
subject
keywords
cardiovascular disease, diabetes mellitus, risk factors, vasculature
in
Journal of Internal Medicine
volume
278
issue
3
pages
291 - 302
publisher
Wiley-Blackwell Publishing Ltd
external identifiers
  • wos:000359364000006
  • scopus:84938738406
ISSN
1365-2796
DOI
10.1111/joim.12359
language
English
LU publication?
yes
id
09ee155b-d8b5-4f0a-ad38-0e87fb35fb34 (old id 7975791)
date added to LUP
2015-10-01 07:35:02
date last changed
2017-10-01 04:04:16
@article{09ee155b-d8b5-4f0a-ad38-0e87fb35fb34,
  abstract     = {BackgroundThere is a need to develop and validate surrogate markers of cardiovascular disease (CVD) in subjects with diabetes. The macrovascular changes associated with diabetes include aggravated atherosclerosis, increased arterial stiffness and endothelial dysfunction. The aim of this study was to determine which of these factors is most strongly associated with clinically manifest cardiovascular events. MethodsVascular changes were measured in a cohort of 458 subjects with type 2 diabetes (T2D) and CVD (myocardial infarction, stroke or lower extremity arterial disease), 527 subjects with T2D but without clinically manifest CVD and 515 subjects without T2D and with or without CVD. ResultsCarotid intima-media thickness (IMT) and ankle-brachial pressure index were independently associated with the presence of CVD in subjects with T2D, whereas pulse wave velocity and endothelial function provided limited independent additive information. Measurement of IMT in the carotid bulb provided better discrimination of the presence of CVD in subjects with T2D than measurement of IMT in the common carotid artery. The factors most significantly associated with increased carotid IMT in T2D were age, disease duration, systolic blood pressure, impaired renal function and increased arterial stiffness, whereas there were no or weak independent associations with metabolic factors and endothelial dysfunction. ConclusionsMeasures of atherosclerotic burden are associated with clinically manifest CVD in subjects with T2D. In addition, vascular changes that are not directly related to known metabolic risk factors are important in the development of both atherosclerosis and CVD in T2D. A better understanding of the mechanisms involved is crucial for enabling better identification of CVD risk in T2D.},
  author       = {Shore, A. C. and Colhoun, H. M. and Natali, A. and Palombo, C. and Östling, Gerd and Aizawa, K. and Kennback, C. and Casanova, F. and Persson, Margaretha and Gooding, K. and Gates, P. E. and Khan, F. and Looker, H. C. and Adams, F. and Belch, J. and Pinnoli, S. and Venturi, E. and Morizzo, C. and Goncalves, Isabel and Ladenvall, Claes and Nilsson, Jan},
  issn         = {1365-2796},
  keyword      = {cardiovascular disease,diabetes mellitus,risk factors,vasculature},
  language     = {eng},
  number       = {3},
  pages        = {291--302},
  publisher    = {Wiley-Blackwell Publishing Ltd},
  series       = {Journal of Internal Medicine},
  title        = {Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study},
  url          = {http://dx.doi.org/10.1111/joim.12359},
  volume       = {278},
  year         = {2015},
}