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(Stroke. 1996;27:1986-1992.)
© 1996 American Heart Association, Inc.

Articles

Carotid Artery Intima-Media Thickness in Elderly Patients With NIDDM and in Nondiabetic Subjects

Leo Niskanen, MD; Rainer Rauramaa, MD; Heikki Miettinen, MD; Steven M. Haffner, MD; Michele Mercuri, MD Matti Uusitupa, MD

the Departments of Clinical Nutrition (L.N., M.U.) and Medicine (L.N., H.M.) and the Kuopio Research Institute of Exercise Medicine and Department of Physiology (R.R.), University of Kuopio (Finland); the Department of Medicine, Division of Clinical Epidemiology, University of Texas Health Science Center at San Antonio (H.M., S.M.H.); and the Division of Vascular Ultrasound Research, Bowman Gray School of Medicine, Winston-Salem, NC (M.M.).

Correspondence to Steven M. Haffner, MD, University of Texas Health Science Center at San Antonio, Department of Medicine, Division of Clinical Epidemiology, 7703 Floyd Curl Dr, San Antonio, TX 78284-7873. E-mail haffner@uthscsa.edu.

Background and Purpose The risk of atherosclerotic vascular disease is increased both in subjects with non–insulin-dependent diabetes mellitus (NIDDM) and in those with impaired glucose tolerance compared with nondiabetic subjects. Although classic cardiovascular risk factors are operative in subjects with NIDDM, other factors closely related to insulin resistance syndrome such as diabetic dyslipidemia and hyperglycemia itself may contribute to an excessive cardiovascular disease risk in subjects with NIDDM. The purpose of this study was to investigate the carotid intimal-medial thicknesses (IMTs) and their determinants in elderly patients with NIDDM and in control subjects.

Methods We investigated the common carotid and carotid bifurcation IMTs and their determinants in groups of elderly patients (n=84, age 67.2±0.6 years) with NIDDM and in 119 control subjects (21 with impaired and 98 with normal glucose tolerance; ages 67.5±1.0 and 65.1±0.6 years, respectively).

Results Common carotid and carotid bifurcation IMTs were greater in the NIDDM group than in control subjects (P<.05 to .01). In NIDDM patients, the mean carotid IMT correlated with postglucose 1-hour plasma insulin (r=.305, P=.01, adjusted for age and sex), serum LDL triglyceride (r=.237, P<.05), and apolipoprotein B concentrations (r=.263, P<.05). Fasting plasma immunoreactive insulin, proinsulin, or specific insulin levels were not significantly associated with carotid IMT. Both diabetic status (P<.05) and the presence of clinical macrovascular disease (P<.01) contributed independently to carotid IMT.

Conclusions Carotid IMT was greater in NIDDM patients than in control subjects. The main determinants of IMT in NIDDM patients were related to both postglucose insulin levels and abnormal lipoprotein profiles characteristic of NIDDM and insulin resistance syndrome. Treatment of these factors is likely to reduce the atherosclerotic burden in NIDDM.

Key Words: aged • apolipoproteins • carotid artery diseases • diabetes mellitus • ultrasonics

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