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(Stroke. 2008;39:e175.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Interplay of Vascular Phenotype and Metabolic Phenotype in Populations With or Without Type 2 Diabetes

University Heart Institute, Skopje, Macedonia

To the Editor:

Recently, Dr Sourij and colleagues¹ concluded that insulin resistance is one of the main factors for carotid atherosclerosis measured as intima-media thickness (IMT). There was evidence given in this article that HOMA index rather than Short Insulin Tolerance Test is associated with carotid IMT. HDL has been inversely related to carotid atherosclerosis by the Insulin Resistance Atheroscterosis Study (IRAS).² Metabolic syndrome amplifies LDL-related increase of carotid IMT in the general population.³ Arterial hypertension and increased waist have been also related to carotid IMT.^4,5

Dehnavi in his study hypothesized that metabolic syndrome as clinical expression of insulin resistance, as well as low-grade systemic inflammation modify the extent of atherosclerosis in type 2 diabetes (T2DM).⁶ The study proved this thesis using sonographic measurements for carotid IMT for vascular phenotype determination. Ethiopathogenesis of carotid artery disease is a result of several factors: hiperinsulinemia, low HDL, high LDL, obesity and arterial hypertension.^7–9 Individual constellation of metabolic syndrome predicts presence of carotid artery disease in a type 2 diabetes population.¹⁰

Today there is no doubt that by targeting metabolic risk factors we reduce a global risk of patients with or without type 2 diabetes.¹¹ Do we still need to estimate HOMA index, or is it necessary to estimate its clinical entity (metabolic syndrome)? What does Dr Sourij’s team mean by this?

Acknowledgments

Disclosures

None.

References

1. Sourij H, Schmoelzer I, Dittrich P, Paulweber B, Iglseder B, Wascher TC. Insulin resistance as a risk factor for carotid atherosclerosis: a comparison of the homeostasis model assessment and the short insulin tolerance test. Stroke. 2008; 39: 1349–1351.[Abstract/Free Full Text]

2. Wagenknecht LE, D'Agostino R Jr, Savage PJ, O'Leary DH, Saad MF, Haffner SM. Duration of diabetes and carotid wall thickness: The Insulin Resistance Atherosclerosis Study (IRAS). Stroke. 1997; 28: 999–1005.[Abstract/Free Full Text]

3. Kawamoto R, Tomita H, Oka Y, Kodama A, Kamitami A. Metabolic syndrome amplifies the LDL-cholesterol associated increases in carotid atherosclerosis. Intern Med. 2005; 44: 1232–1238.[CrossRef][Medline] [Order article via Infotrieve]

4. Rajala U, Laakso M, Paivansalo M. Low insulin sensitivity measured by both quantitative insulin sensitive check index and homeostasis model assessment method as a risk factor of increased intima-media thickness of the carotid artery. J Clin Endocrinol Metab. 2002; 87: 5092–5097.[Abstract/Free Full Text]

5. Szernichow S, Bertrais S, Oppert JM, Galan P, Blacher J, Ducimetiere P, Hercberg S, Satar M, Zureik M. Body composition and after repartition in relation to structure and function of a large arteries in middle-aged adults (the SU.VI.MAX study). Int J Obes. 2005; 29: 826–832.[CrossRef][Medline] [Order article via Infotrieve]

6. Dehnavi RA, Beishuizen ED, van de Ree MA, Le Cessie S, Huisman MV, Kluft C, Princen HM, Tamsma JT. The impact of metabolic syndrome and CRP on vascular phenotype in type 2 diabetes mellitus. Eur J Intern Med. 2008; 19: 115–121.[CrossRef][Medline] [Order article via Infotrieve]

7. Williams R, Aiery M. Epidemiology and pathogenesis of diabetic angiopathy. In: Tooke J. Diabetic Angiopathy. London: Arnold; 1999.

8. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults. JAMA. 2002; 287: 356–359.[Abstract/Free Full Text]

9. Pollex R, Al-Shalli KZ, House AA, Spence JD, Fenster A, Mamakeesick M, Zinman B, Harris SB, Hanley AJ, Hegele RA. Relationship of metabolic syndrome to carotid ultrasound traits. Cardiovascular Ultrasound. 2006; 4: 28–35.[CrossRef][Medline] [Order article via Infotrieve]

10. Bosevski M, Borozanov V, Georgievska-Ismail L. Influence of metabolic risk factors on the presence of carotid artery disease in patients with type 2 diabetes and coronary artery disease. Diab Vasc Dis Res. 2007; 4: 49–52.[Abstract/Free Full Text]

11. Grant PJ. Diabetes mellitus and vascular disease: targeting cardiometabolic risk. Diab Vasc Dis Res. 2008; 5: 7–8.[Free Full Text]

This Article Extract Full Text (PDF) All Versions of this Article: 39/11/e175    most recent STROKEAHA.108.528372v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bosevski, M. Search for Related Content PubMed PubMed Citation Articles by Bosevski, M.