Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes

a European cross-sectional study

A. C. Shore, H. M. Colhoun, A. Natali, C. Palombo, G. Östling, K. Aizawa, C. Kennbäck, F. Casanova, M. Persson, P. E. Gates, Faisel Khan, H. C. Looker, F. Adams, Jill Belch, S. Pinnoli, E. Venturi, C. Morizzo, I. Goncalves, C. Ladenvall, J. Nilsson (Lead / Corresponding author) & 1 others SUMMIT Consortium

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: There 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. Methods: Vascular 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. Results: Carotid 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. Conclusions: Measures 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.

Original languageEnglish
Pages (from-to)291-302
Number of pages12
JournalJournal of Internal Medicine
Volume278
Issue number3
Early online date13 Apr 2015
DOIs
Publication statusPublished - Sep 2015

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Type 2 Diabetes Mellitus
Cardiovascular Diseases
Cross-Sectional Studies
Carotid Intima-Media Thickness
Vascular Stiffness
Blood Vessels
Atherosclerosis
Blood Pressure
Ankle Brachial Index
Pulse Wave Analysis
Common Carotid Artery
Lower Extremity
Biomarkers
Stroke
Myocardial Infarction
Kidney
Pressure

Keywords

  • Cardiovascular disease
  • Diabetes mellitus
  • Risk factors
  • Vasculature

Cite this

Shore, A. C. ; Colhoun, H. M. ; Natali, A. ; Palombo, C. ; Östling, G. ; Aizawa, K. ; Kennbäck, C. ; Casanova, F. ; Persson, M. ; Gates, P. E. ; Khan, Faisel ; Looker, H. C. ; Adams, F. ; Belch, Jill ; Pinnoli, S. ; Venturi, E. ; Morizzo, C. ; Goncalves, I. ; Ladenvall, C. ; Nilsson, J. ; SUMMIT Consortium. / Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes : a European cross-sectional study. In: Journal of Internal Medicine. 2015 ; Vol. 278, No. 3. pp. 291-302.
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abstract = "Background: There 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. Methods: Vascular 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. Results: Carotid 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. Conclusions: Measures 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.",
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Shore, AC, Colhoun, HM, Natali, A, Palombo, C, Östling, G, Aizawa, K, Kennbäck, C, Casanova, F, Persson, M, Gates, PE, Khan, F, Looker, HC, Adams, F, Belch, J, Pinnoli, S, Venturi, E, Morizzo, C, Goncalves, I, Ladenvall, C, Nilsson, J & SUMMIT Consortium 2015, 'Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes: a European cross-sectional study', Journal of Internal Medicine, vol. 278, no. 3, pp. 291-302. https://doi.org/10.1111/joim.12359

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, G.; Aizawa, K.; Kennbäck, C.; Casanova, F.; Persson, M.; Gates, P. E.; Khan, Faisel; Looker, H. C.; Adams, F.; Belch, Jill; Pinnoli, S.; Venturi, E.; Morizzo, C.; Goncalves, I.; Ladenvall, C.; Nilsson, J. (Lead / Corresponding author); SUMMIT Consortium.

In: Journal of Internal Medicine, Vol. 278, No. 3, 09.2015, p. 291-302.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Measures of atherosclerotic burden are associated with clinically manifest cardiovascular disease in type 2 diabetes

T2 - a European cross-sectional study

AU - Shore, A. C.

AU - Colhoun, H. M.

AU - Natali, A.

AU - Palombo, C.

AU - Östling, G.

AU - Aizawa, K.

AU - Kennbäck, C.

AU - Casanova, F.

AU - Persson, M.

AU - Gooding, K.

AU - Gates, P. E.

AU - Khan, Faisel

AU - Looker, H. C.

AU - Adams, F.

AU - Belch, Jill

AU - Pinnoli, S.

AU - Venturi, E.

AU - Morizzo, C.

AU - Goncalves, I.

AU - Ladenvall, C.

AU - Nilsson, J.

AU - SUMMIT Consortium

PY - 2015/9

Y1 - 2015/9

N2 - Background: There 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. Methods: Vascular 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. Results: Carotid 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. Conclusions: Measures 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.

AB - Background: There 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. Methods: Vascular 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. Results: Carotid 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. Conclusions: Measures 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.

KW - Cardiovascular disease

KW - Diabetes mellitus

KW - Risk factors

KW - Vasculature

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