Published Online
on February 12, 2004

A more recent version of this article appeared on March 1, 2004

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Submitted on September 11, 2003
Accepted on November 6, 2003

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; and 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.

^* To whom correspondence should be addressed. 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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