Carotid intima-media thickness:influence of drug treatment and clinical implications

With B-mode ultrasound measurements of the intima-media thickness (IMT) of the carotid arterial wall (asymptomatic) atherosclerosis can be detected. In this article several studies are reviewed in which IMT was used as a surrogate endpoint to assess effects of lipid-lowering or antihypertensive drugs on peripheral atherosclerosis, and the clinical implications are discussed. After 1 year of treatment with lipid-lowering drugs an improvement of the blood Lipid profile and retarded progression of the carotid IMT was seen. No incontrovertible evidence can be provided for a correlation between induced changes in the carotid and coronary arteries. Carotid WIT appears to be of prognostic value for cardiovascular events. The range of treatment-induced changes in IMT do not support the use of IMT in an individual patient to monitor treatment effects. However, with increased IMT as independent cardiovascular risk factor, TMT measurements are valuable in risk assessment in the individual patient in clinical practice. Looking forward to some ongoing studies, there is so far insufficient evidence that treating hypertension also inhibits progression of the TMT. (C) 1999 Elsevier Science B.V. All rights reserved

Walking training for intermittent claudication in diabetes

OBJECTIVE - Walking training (WT) is an established treatment for patients with intermittent claudication (IC). Abnormalities specific to diabetes, such as a relative preponderance of distal lesions and the contribution of microcirculatory disease, might well influence the results of WT. We compared changes in walking distance during WT in diabetic patients with those in nondiabetic control subjects. RESEARCH DESIGN AND METHODS - In consecutive patients with limiting IC and proven peripheral vascular disease, 33 patients with diabetes were compared with 136 control subjects during a half-year supervised WT program. Walking parameters were determined every 2 months, while vascular parameters were obtained at the start and end of the program. RESULTS - Of the 33 diabetic patients, 25 (76%) completed the program, as did 87 of the 136 (64%) control subjects. Thereafter, the symptom-free walking distance and the maximum walking distance (MWD) were significantly increased in diabetic patients from 142 +/- 30 to 339 +/- 57 m and from 266 +/- 39 to 603 +/- 52 m, respectively, and in control subjects from 176 +/- 8 to 400 +/- 39 m and from 292 +/- 18 to 628 +/- 36 m, respectively. The relative gain in MWD was 88% greater in those with diabetes. The vascular parameters were comparable for both groups before and after WT: CONCLUSIONS - WT is an effective treatment for IC, with a greater relative gain in diabetic patients