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(Stroke. 2004;35:671.)
© 2004 American Heart Association, Inc.

Original Contributions

Carotid Arterial Remodeling

A Maladaptive Phenomenon in Type 2 Diabetes but Not in Impaired Glucose Metabolism: The Hoorn Study

Ronald M.A. Henry, MD; Piet J. Kostense, PhD; Jacqueline M. Dekker, PhD; Giel Nijpels, MD, PhD; Robert J. Heine, MD, PhD; Otto Kamp, MD, PhD; Lex M. Bouter, PhD Coen D.A. Stehouwer, MD, PhD

From the Institute for Research in Extramural Medicine (R.M.A.H., P.J.K., J.M.D., G.N., R.J.H., L.M.B., C.D.A.S.), Institute for Cardiovascular Research (R.M.A.H.), and Departments of Clinical Epidemiology and Biostatistics (P.J.K.), Cardiology (O.K.), Endocrinology (R.J.H.), and Internal Medicine (C.D.A.S.), VU Medical Center, Amsterdam, the Netherlands.

Correspondence to Professor C.D.A. Stehouwer, MD PhD, Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands. E-mail cda.stehouwer{at}vumc.nl

Background and Purpose— Deteriorating glucose tolerance is associated with an increased cardiovascular disease (CVD) risk. The underlying mechanisms remain unclear. Arterial remodeling is the change in structural properties through time in response to atherogenic and/or hemodynamic alterations and aims to maintain circumferential wall stress constant (_C). Arterial remodeling has not been studied in relation to glucose tolerance.

Methods— The study population consisted of 278 people with normal glucose metabolism, 168 with impaired glucose metabolism, and 301 with type 2 diabetes (DM-2); their mean age was 67.8 years. We assessed carotid intima-media thickness (IMT), interadventitial diameter (IAD), lumen diameter (LD), and _C.

Results— After adjustment for age, sex, height, body mass index, and prior CVD, DM-2 was associated with increased IAD, IMT, and _C but not LD (regression coefficients: 0.24 mm; 95% confidence interval [CI], 0.07 to 0.41; 0.050 mm; 95% CI, 0.024 to 0.077; 5.00 kPa; 95% CI, 0.92 to 9.08; and 0.13 mm; 95% CI, -0.03 to 0.29, respectively). After additional adjustment for pulse pressure, the association between DM-2 and IAD disappeared, whereas the association with IMT remained. After adjustment, impaired glucose metabolism was not significantly associated with LD (0.12 mm; 95% CI, -0.06 to 0.33), _C (0.25 kPa; 95% CI, -4.49 to 4.98), IAD (0.08 mm; 95% CI, -0.11 to 0.27), or IMT (0.029 mm; 95% CI, -0.002 to 0.060). However, the IMT regression coefficient was half that of DM-2.

Conclusions— DM-2 is associated with preserved LD at increased IMT, which, however, does not normalize the increased _C. In contrast, impaired glucose metabolism is not associated with changes in LD or IAD, whereas IMT is moderately increased but _C remains constant. Carotid remodeling in DM-2 thus appears maladaptive, which may explain the increased CVD risk, especially stroke, in DM-2.

Key Words: arterial remodeling • carotid arteries • diabetes mellitus • epidemiology

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