Carotid intima media thickness in type 2 diabetes mellitus with ischemic cerebrovascular stroke and its utility as a marker for predicting cerebrovascular disease

Authors

  • Mohita Shah Department of General Medicine, SMIMER, Surat, Gujarat, India
  • Prafful Kothari Department of General Medicine, SMIMER, Surat, Gujarat, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20220122

Keywords:

Carotid IMT, Diabetes mellites, Atherosclerosis

Abstract

Background: In India, the national prevalence of diabetes mellitus (DM) is estimated at 18.2%. More than half of all diabetic deaths are accounted for by atherosclerotic disease leading to cardiovascular or cerebral complications. Intima media thickness (IMT), a measure of atherosclerotic vascular disease. It can easily be measured especially at the carotids by B mode ultrasonography, a relatively simple way representing a safe, precise, and reproducible measure. It has therefore been proposed as a non-invasive measure of predicting chances of cerebrovascular disease burden in adults.

Methods: A total of 60 subjects in the age group of 30-75 years (M:F=37:23) were selected and divided into three groups, group C: Patients of either sex in the age group of 30-75 years with type 2 DM (T2DM) with or without hypertension with ischemic stroke demonstrated on CT scan. Group B: Age-matched T2DM patients of either sex without any prior history of transient ischemic attack or stroke. Group A: Age-matched normal individuals of either sex. The following groups of diabetic patients with stroke were excluded from our study: cardioembolic stroke, patients with hemorrhagic stroke, and patients with stroke due to secondary causes like trauma, impaired coagulation or tumor.

Results: Average mean common carotid artery IMT (CCA-IMT) ranged from 0.72 to 0.97 mm across cohorts in people with diabetes. Patients with T2DM with ischemic stroke were found to have significantly higher prevalence of increased CIMT and a value greater than 0.8 mm was found to be associated with the occurrence of stroke. The mean CIMT was significantly higher in diabetic subjects compared to healthy subjects.

Conclusions: A high CIMT is a surrogate and reliable marker of higher risk of cerebrovascular accidents amongst type 2 diabetic patients. Our study demonstrates the utility of carotid IMT as a simple non-invasive screening test for the assessment of atherosclerosis risk/prognosis in T2DM.

References

Brohall G, Odén A, Fagerberg B. Carotid artery intima-media thickness in patients with Type 2 diabetes mellitus and impaired glucose tolerance: a systematic review. Diabet Med. 2006;23(6):609-16.

Adaikkappan M, Sampath R, Felix AJW, Sethupathy S. Evaluation of carotid atherosclerosis by B'mode ultrasonographic study in hypertensive patients compared with normotensive patients. Indian J Radiol Imaging. 2002;12(3):365-8.

Dikanovic M, Hozo I, Kokia S, Tithic M. Transcranial Doppler ultrasound assessment of intracranial haemodynamics in patients with typ 2 diabetes mellitus. Ann Saudi Med. 2005;25:486-8.

Ito H, Komatsu Y, Mifune M, Antoku S, Ishida H, Takeuchi Y et al. The estimated GFR, but not the stage of diabetic nephropathy graded by the urinary albumin excretion, is associated with the carotid intima-media thickness in patients with type 2 diabetes mellitus: a cross-sectional study. Cardiovasc Diabetol. 2010;9:18-10.

Kota SK, Mahapatra GB, Kota SK, Naveed S, Tripathy PR, Jammula S et al. Carotid intima media thickness in type 2 diabetes mellitus with ischemic stroke. Indian J Endocrinol Metab. 2013;17(4):716-22.

Lorenz MW, Price JF, Robertson C, Bots ML, Polak JF, Poppert H et al. Carotid intima-media thickness progression and risk of vascular events in people with diabetes: results from the PROG-IMT collaboration. Diabetes Care. 2015;38(10):1921-9.

Bartman W, Pierzchała K. Clinical determinants of carotid intima-media thickness in patients with diabetes mellitus type 2. Neurol Neurochir Pol. 2012;46(6):519-28.

Barghouti N, Elkeles R, Nicolaides A, Geroulakos G, Dhanjil S, Diamond J. The ultrasonic evaluation of the carotid intima-media thickness and its relation to risk factors of atherosclerosis in normal and diabetic population. Int Angiol. 1997;16(1):50-4.

Poredos P. Intima-media thickness: indicator of cardiovascular risk and measure of the extent of atherosclerosis. Vasc Med. 2004;9(1):46-54.

Aminbakhsh A, Mancini GB. Carotid intima-media thickness measurements: what defines an abnormality? A systematic review. Clin Invest Med. 1999;22(4):149-57.

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Published

2022-01-25

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Original Research Articles