Microangiopathy is independently associated with presence, severity and composition of carotid atherosclerosis in type 2 diabetes

Vigili de Kreutzenberg, S.; Coracina, A.; Volpi, A.; Fadini, G.P.; Frigo, A.C.; Guarneri, G.; Tiengo, A.; Avogaro, A.

doi:10.1016/j.numecd.2009.10.003

« Previous Next »Nutrition, Metabolism & Cardiovascular Diseases
Volume 21, Issue 4 , Pages 286-293, April 2011

Microangiopathy is independently associated with presence, severity and composition of carotid atherosclerosis in type 2 diabetes

S. Vigili de Kreutzenberg
- Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
- Corresponding author. Tel.: +39 49 8212183; fax: +39 49 8754179.
A. Coracina
- Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
A. Volpi
- Diabetologic Unit, Montebelluna Hospital, Treviso, Italy
G.P. Fadini
- Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
A.C. Frigo
- Department of Environmental Medicine and Public Health, University of Padova, Italy
G. Guarneri
- Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
A. Tiengo
- Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy
A. Avogaro
- Department of Clinical and Experimental Medicine, University of Padova, Via Giustiniani, 2, 35128 Padova, Italy

Received 14 July 2009; received in revised form 7 October 2009; accepted 9 October 2009. published online 17 February 2010.

Abstract

Background and aims

Common mechanisms for the development of micro- and macroangiopathic diabetic complications have been suggested. We aimed to cross-sectionally investigate strength and characteristics of the association between carotid atherosclerosis and microangiopathy in type 2 diabetic patients.

Methods and results

Common carotid artery intima–media thickness (cIMT), carotid plaque (CP) type and degree of stenosis were evaluated by ultrasound, along with the determination of anthropometric parameters, HbA1c, lipid profile, assessment of diabetic retinopathy and nephropathy, in 662 consecutive patients with type 2 diabetes mellitus (T2DM). Patients were divided according to high/low cIMT, presence/absence of CP and of retinopathy and nephropathy. Patients with CP were older, more prevalently males, past smokers, had longer diabetes duration, significantly lower HDL cholesterol and more prevalent ischemic heart disease (all p<0.05) as compared to those with cIMT<1mm. Microangiopathies were more prevalent in patients with CP than in those without. At multivariate logistic regression, factors independently associated with the presence of CP were age, past smoke, HDL cholesterol, retinopathy and retinopathy plus nephropathy. A significant independent correlation of CP stenosis with stage of retinopathy and nephropathy was found. Finally, echolucent CPs were associated with a lower prevalence of proliferative retinopathy than CP containing calcium deposits.

Conclusion

In T2DM, retinopathy, alone or in combination with nephropathy, is independently associated to CP, and severity of microangiopathy correlates with severity of carotid atherosclerosis. These observations, together with the different prevalence of proliferative retinopathy according to CP types, point to possible common pathogenic mechanisms in micro- and macrovascular complications.

Keywords: Type 2 diabetes mellitus, Microangiopathy, Carotid atherosclerosis