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(Stroke. 1997;28:999-1005.)
© 1997 American Heart Association, Inc.
Articles |
Duration of Diabetes and Carotid Wall Thickness
The Insulin Resistance Atherosclerosis Study (IRAS)
From the Department of Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (L.E.W., R.D'A.); Division of Epidemiology and Clinical Applications, National Institutes of Health, National Heart, Lung, and Blood Institute, Bethesda, Md (P.J.S.); Department of Radiology, New England Medical Center, Boston, Mass (D.H.O'L.); Department of Medicine, University of Southern California Medical Center, Los Angeles (M.F.S.); and Department of Medicine, University of Texas Health Science Center at San Antonio (S.M.H.).
Correspondence to Dr Lynne E. Wagenknecht, Department of Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Blvd, Winston-Salem, NC 27157. E-mail LWAGENKN{at}RC.PHS.BGSM.EDU
Background and Purpose Diabetes is a major risk factor for morbidity and mortality from cardiovascular disease. However, the role of the primary metabolic abnormality of diabetes (chronic hyperglycemia) in this disease process has not been fully elucidated.
Methods A cross-sectional analysis was conducted among 489 persons with non–insulin-dependent diabetes mellitus; 299 were established diabetics (diagnosed previously) and 190 were newly diagnosed at the time of the Insulin Resistance Atherosclerosis Study (IRAS) examination. These men and women, of three different ethnic groups, were participants in IRAS. Established diabetes (versus newly diagnosed diabetes) and mean fasting glucose level were used as measures of hyperglycemic burden. Intimal-medial wall thickness (IMT) of the internal (ICA) and common (CCA) carotid arteries were used as indices of atherosclerosis.
Results The mean duration of disease among established diabetics was 7 years. The mean CCA IMT and ICA IMT were 872 and 946 µm, respectively. Established diabetes and mean fasting glucose level were positively associated with increased CCA IMT (P<.05) but not ICA IMT, even after adjustment for numerous cardiovascular disease risk factors. CCA IMT was increased by 70 µm in established diabetics (versus newly diagnosed diabetics) and by 26 µm per 1 SD of fasting glucose. Among established diabetics, however, duration of known diabetes (number of years) was not significantly related to IMT.
Conclusions Among diabetics in IRAS, established diabetes and fasting glucose level were each independently associated with CCA IMT, suggesting that chronic hyperglycemia or its associated metabolic abnormalities may lead to increased risk of atherosclerosis.
Key Words: atherosclerosis • carotid arteries • diabetes mellitus • hyperglycemia
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