Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality among subjects with type 2 diabetes (T2D), and diabetic retinopathy (DR) has been associated with an increased risk for CVD. The present study was designed to test the concept that T2D patients with DR, but without previous cardiovascular (CV) events and with normal renal function, have an increased atherosclerotic burden compared with patients without DR. METHODS: A cross-sectional study was performed using patients with normal renal function (estimated glomerular filtration rate (eGFR) >60 ml/min) and without previous CV events. A total of 312 patients (men, 51%; mean age, 57 yrs; age range 40-75 yrs) were included in the study; 153 (49%) of the patients had DR. B-mode carotid ultrasound imaging was performed for all of the study subjects to measure the carotid intima-media thickness (cIMT) and carotid plaques in the common carotid artery (CCA), bifurcation and internal carotid artery (ICA). RESULTS: The percentage of carotid plaques in T2D patients with DR was higher than in T2D patients without DR (68% vs. 52.2%, p = 0.0045), and patients with DR had a higher prevalence of ≥2 carotid plaques (44.4% vs. 21.4%; p < 0.0001). No differences were observed in the cIMT measured at different carotid regions between the patients with or without DR. Using multivariate logistic regression (adjustment for major risk factors for atherosclerosis), DR was independently associated with mean-internal cIMT (p = 0.0176), with the presence of carotid plaques (p = 0.0366) and with carotid plaque burden (≥2 plaques; p < 0.0001). CONCLUSIONS: The present study shows that DR in T2D patients without CVD and with normal renal function is associated with a higher atherosclerotic burden (presence and number of plaques) in the carotid arteries. These patients may be at a higher risk for future CV events; therefore, an ultrasound examination of the carotid arteries should be considered in patients with DR for more careful and individualised CV assessment and follow-up

The role of vascular biomarkers for primary and secondary prevention. A position paper from the European Society of Cardiology Working Group on peripheral circulation

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Predictors of cardiovascular disease and mortality in patients with advanced chronic kidney disease

Cardiovascular disease is the leading cause of high mortality in advanced chronic kidney disease (CKD) patients. Treatment and prevention of cardiovascular disease should be in focus to improve prognosis in this high-risk population. The aim of the study was to assess cardiovascular determinants of mortality, to study the effect of diabetes on arterial endothelial function and structure, to evaluate exercise capacity and abdominal aortic calcification (AAC) in patients with advanced CKD, not on dialysis. 210 participants of the Chronic Arterial Disease, quality of life and mortality in chronic KIDney injury -study underwent maximal bicycle ergometry stress test, echocardiography, lateral lumbar radiograph to study AAC score, ultrasound measures of arterial structure and function, and laboratory measures. Determinants of mortality were stress ergometry performance, AAC score, E/e’ ratio of echocardiography, and cardiac biomarkers and albumin. Diabetes was a significant determinant of AAC but did not associate with endothelial dysfunction or increased carotid intima-media thickness. Maximal stress ergometry performance was associated with troponin T (TnT) and AAC. The progression of AAC was rapid and the increment rate was similar in patients transitioning to different modalities of renal replacement therapy. To conclude, stress ergometry performance, AAC, E/e’ of echocardiography, and cardiac biomarkers and albumin predict mortality, and diabetes is associated with AAC in advanced CKD. TnT and AAC are associated with maximal ergometry stress test and AAC progresses at a comparable rate across the CKD treatment groups.Sydän- ja verisuonitautien ja kuolleisuuden ennustekijät loppuvaiheen munuaisten vajaatoimintaa sairastavilla Loppuvaiheen munuaisten vajaatoimintapotilailla sydän- ja verisuonitaudit ovat johtava kuolleisuuden syy. Sydän- ja verisuonitautien hoito ja ennaltaehkäisy tulisi olla keskiössä tämän korkean riskin ryhmän ennusteen parantumiseksi. Tutkimuksessa arvioitiin kuolleisuuteen vaikuttavia sydän- ja verisuonitautitekijöitä, diabeteksen vaikutusta verisuonen sisäkalvon toimintaan ja suonirakenteeseen, suorituskykyä, sekä vatsa-aortan kalkkisuutta ei-dialyysihoitoisessa loppuvaiheen munuaisten vajaatoiminnassa. 210 potilasta osallistui Krooninen valtimotauti, elämänlaatu ja mortaliteetti vaikeaa munuaisten vajaatoimintaa sairastavilla -tutkimukseen. Tutkittaville tehtiin polkupyörärasituskoe, sydämen ultraäänitutkimus, lannerangan röntgenkuvaus aortan kalkkisuuden määrittämiseksi, verisuoniultraäänitutkimus verisuonen rakenteen ja toiminnan tutkimiseksi sekä otettiin laboratoriokokeet. Kuolleisuutta määrittivät suorituskyky, vatsa-aortan kalkkisuus, sydämen ultraäänitutkimuksen E/e’ suhde, sydänmerkkiaineet ja albumiini. Diabetes määritti vatsa-aortan kalkkisuutta merkittävästi, mutta ei ollut yhteydessä verisuonen laajenemiskykyyn eikä kaulavaltimon seinämäpaksuuteen. Maksimaalinen suorituskyky oli yhteydessä troponiini T:hen (TnT) ja vatsa-aortan kalkkisuuteen. Vatsaaortan kalkkisuus kehittyi nopeasti ja kehityksen suuruus oli sama eri keinomunuaishoitomuodoissa. Yhteenvetona todetaan, että suorituskyky, vatsa-aortan kalkkisuus, sydämen ultraäänitutkimuksen E/e’ suhde, sydänmerkkiaineet ja albumiini ennustavat kuolleisuutta, ja diabetes on yhteydessä vatsa-aortan kalkkisuuteen, mutta ei verisuonen laajenemiskykyyn tai sisäkalvopaksuuteen, loppuvaiheen munuaisten vajaatoiminnassa. TnT ja vatsa-aortan kalkkisuus ovat yhteydessä maksimaaliseen suorituskykyyn, ja vatsa-aortan kalkkisuus etenee samalla nopeudella eri munuaiskorvaushoitomuodoissa

High resolution ultrasound and arterial wall changes in early atherosclerosis

Non-invasive vascular testing evolved initially to meet the needs of the surgeon to identify haemodynamically significant lesions. However, with refinement of techniques and the development of high resolution ultrasound, it has become possible to detect early lesions and to measure the thickness of die arterial wall with an accuracy of 0.2mm. Such measurements have epidemiological and prognostic potential. They may allow the study of progression (or regression) of atherosclerotic disease before symptoms develop. The aim of this thesis was to assess the value of arterial wall measurements of intima-media thickness and compliance of the common carotid artery in the prediction of early atherosclerotic disease. Four different anatomical patterns of carotid bulb morphology have been identified, according to the position of the bulb origin in relation to the flow divider. It has been demonstrated that bulb morphology influences the site of early plaque formation. The presence of plaque at the carotid and femoral bifurcations was found to be associated with increased intima-media thickening of the common carotid artery. Histological analysis of common carotid arteries taken at post-mortem showed that this diffuse intima-media thickening is the result of deposition of cholesterol crystals, medial atrophy, fatty and fibrous change, and accumulation of necrotic debris, the features characteristic of plaques, even though discrete plaques rarely occur at this site. Subsequently, a number of clinical studies were undertaken which demonstrated that the intima-media thickness is increased in diabetics, hypopituitary patients and claudicants as compared to controls. It was found that the intima-media thickness of the common carotid artery could be used to predict the presence of bifurcation plaques and macrovascular disease. The work of this thesis has demonstrated that high resolution ultrasound is a powerful technique for die study of the arterial wall and should be tested in prospective studies for its suitability as an epidemiological tool

Clinical application of pulsatility index

Pulsatility index (PI) is defined as the difference between the peak systolic flow and minimum diastolic flow velocity, divided by the mean velocity recorded throughout the cardiac cycle. It is a non-invasive method of assessing vascular resistance with the use of Doppler ultrasonography. It was first introduced in 1974 by Gosling and King and is also known as the Gosling Index. PI as a method of examining macrocirculation has a variety of clinical applications. For instance, in diabetic patients, it has been measured on the common carotid, middle cerebral or renal arteries to help predict complications such as cerebrovascular disease or nephropathy. In hypertensive patients, it has been used to assess complications and assess the chronicity of the disease. To our knowledge, despite the diverse use of this ultrasonographic parameter, there is a deficiency in reports that would comprehensively summarize its clinical applications. Based on our extensive review of the literature and the gathered information, we conclude that pulsatility index (PI) is an easy to obtain parameter with a broad range of both, research and clinical applications. It has been widely used in the assessment of macrocirculation in highly prevalent chronic medical conditions, such as hypertension, both type 1 and type 2 diabetes and thyroid disorders

Correlation of Urine Albumin Creatinine Ratio And C-Reactive Protein Levels on Carotid Artery Intima-Media Thickness And Flow-Mediated Dilatation Response In Children and Adolescent with Type 1 Diabetes Mellitus At Dr Saiful Anwar Hospital Malang

Background:Early and accelerated atherosclerosis is a major cause of cardiovascular disease and often causes premature death in T1DM patients. In DMT1, atherosclerosis can be detected since adolescence. The initial association between urinary albumin to creatinine ratio (ACR) and c-reactive protein (hs-CRP) with subclinical cardiovascular disease in children and adolescents with T1DM supported findings from previous studies. Imaging tests using ultrasound can detect subclinical atherosclerosis in this patient population. Carotid artery intima-media thickness (cIMT) and flow-mediated dilatation response (FMD) have been frequently used to detect subclinical atherosclerosis.Objective: To find correlation between ACR and hsCRP on the thickness values of cIMT and FMD in children and adolescent DMT1 patients at Dr Saiful Anwar Hospital MalangMethods: This is a cross-sectional study with 82 subjects of DMT1 patients who routinely control the pediatric outpatient clinic of RSUD Dr. Saiful Anwar Malang, with the research period January – July 2019 and December 2021 – March 2022.Results: There was correlation between ACR with FMD and cIMT (r=-0.593; p=0.000 and r=0.339; p=0.002, respectively). There was also correlation between hsCRP with FMD and cIMT (p=-0.375; p=0.001 and r= 0.414; p=0.023, respectively).Conclusion: ACR and hsCRP have a correlation with increasing CIMT values and decreasing FMD values in children and adolescents with DMT1 patients

Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients

Impact of carotid atherosclerosis on long-term mortality in chronic hemodialysis patients.BackgroundCardiovascular event is the major cause of mortality in patients on maintenance hemodialysis. We prospectively tested the predictive values of atherosclerotic parameters for all-cause and cardiovascular outcomes in 219 hemodialysis patients (age, 58 ± 13 years; time on hemodialysis, 13 ± 7 years; male/female, 144/75).MethodsWe measured blood homocysteine (Hcy), ultrasound carotid artery intima media thickness (IMT) and % aortic wall calcification at L2/3 region [% of calcification index in the abdominal aortic wall (%ACI)] by computed tomography (CT) scan, and followed all patients for 5 years.ResultsDuring the follow-up periods, 54 patients (25%) died, 40 (74%) of them of cardiovascular causes. IMT was significantly higher in patients who expired (0.75 ± 0.02mm) than in those who survived (0.62 ± 0.01mm). IMT was significantly correlated with age (r = 0.47, P < 0.01) and %ACI (r = 0.27, P < 0.01). The survival rate during the observation was significantly lower in the final IMT third (58%) than in the first (90%) and the middle IMT third (80%) (P < 0.01). Multivariate Cox proportional hazards analysis revealed that diabetes and IMT became independent determinants of all-cause and cardiovascular death. Adjusted hazards ratios of all-cause and cardiovascular mortality for an increase of 0.1mm in IMT were 1.31 (95% CI, 1.07 to 1.59) and 1.41 (95% CI, 1.12 to 1.76). In contrast, %ACI at abdominal aorta and blood Hcy did not affect their 5-year mortality.ConclusionThese findings suggested that measurement of carotid artery IMT is useful for predicting long-term mortality in patients receiving maintenance hemodialysis