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Lack of concordance between plasma markers of cardiovascular risk and intima‐media thickness in patients with type 2 diabetes
Author(s) -
Moussavi N.,
Renier G.,
Roussin A.,
Mamputu J.C.,
Buithieu J.,
Serri O.
Publication year - 2004
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/j.1463-1326.2004.00319.x
Subject(s) - medicine , diabetes mellitus , intima media thickness , type 2 diabetes , endothelial dysfunction , waist , c reactive protein , atenolol , endocrinology , cardiology , gastroenterology , inflammation , body mass index , carotid arteries , blood pressure
Aim: Endothelial dysfunction, oxidative stress and systemic inflammation play an important role in the enhanced cardiovascular risk in diabetes. Carotid intima‐media thickness (IMT), a widely accepted marker of subclinical atherosclerosis, is known to be increased in patients with type 2 diabetes. The relationships between plasma markers of cardiac risk and carotid IMT are not well known. We therefore studied a group of patients with type 2 diabetes to evaluate the relationships between plasma markers of cardiac risk and carotid IMT. Design and patients: We measured carotid IMT and the levels of soluble endothelial adhesion molecules [sE‐selectin, intercellular cell adhesion molecule‐1 (sICAM‐1) and vascular cell adhesion molecule‐1 (sVCAM‐1)], C‐reactive protein (CRP) and 8‐isoprostane in 40 patients with type 2 diabetes without clinical macrovascular complications (HbA 1c < 10%, duration of diabetes < 12 years) and 25 healthy subjects. We then examined the correlations between these plasma markers, carotid IMT and various clinical and biochemical parameters. Results: Diabetic patients had higher plasma sE‐selectin (p = 0.03), sICAM‐1 (p = 0.05), CRP (p = 0.047) and 8‐isoprostane (p = 0.001) concentrations than control subjects. Mean IMT values were identical (0.63 ± 0.02 mm) in diabetic (range, 0.40–0.92 mm) and healthy subjects (range, 0.45–0.85 mm). In diabetic patients, stepwise multivariate analysis showed that HbA 1c and plasma glucose were independent predictors of sE‐selectin ( r 2 = 0.19 and r 2 = 0.17, p < 0.01, respectively), whereas waist circumference and body mass index (BMI) were predictors of sICAM‐1 ( r 2 = 0.27, p = 0.001 and r 2 = 0.22, p = 0.002, respectively). Waist circumference was the only predictor of CRP ( r 2 = 0.2, p < 0.01), and systolic blood pressure was the only predictor of 8‐isoprostane ( r 2 = 0.19, p = 0.006). In control subjects, similar analysis showed that plasma glucose and waist circumference were predictors of sE‐selectin and sICAM‐1, respectively ( r 2 = 0.2, p < 0.05). Conclusions: These results indicate that some well‐controlled type 2 diabetic patients free of clinical macrovascular complications have elevated plasma markers of cardiovascular risk without having increased IMT. The elevation of plasma markers of endothelial cell activation (sE‐selectin and s‐ICAM‐1) or inflammation (CRP) and oxidative stress (8‐isoprostane) in diabetics vs. controls is distinct from and cannot be explained simply by differences in the burden of atherosclerosis as assessed by carotid IMT.