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Carotid artery disease: the influence of diabetes mellitus
R F Drielsma1, J R Burnett, A C Gray-Weale
1University of Sydney, Department of Surgery, Repatriation General Hospital, Concord, Australia.
Insights
Diabetic patients have a higher stroke risk, but their carotid plaque characteristics are similar to non-diabetics. Insulin treatment may reduce plaque complications, suggesting other factors contribute to diabetic stroke risk.
Area of Science:
- Vascular Medicine
- Diabetology
- Neurology
Background:
- Patients with diabetes mellitus exhibit a higher predisposition to stroke compared to non-diabetic individuals.
- Carotid artery atherosclerosis is a significant risk factor for ischemic stroke.
Purpose of the Study:
- To investigate carotid plaque characteristics in diabetic and non-diabetic patients using Duplex ultrasound.
- To explore the relationship between diabetic control and plaque pathology.
- To identify factors contributing to the increased stroke risk in diabetic patients.
Main Methods:
- Duplex ultrasound imaging of the carotid bifurcation was employed.
- A classification system for atherosclerotic plaques based on pathology was utilized.
- Diabetic patients were subdivided based on their mode of diabetic control.
Main Results:
- Diabetics and non-diabetics showed similar ultrasound plaque type distributions in symptomatic patients.
- Insulin-treated diabetics demonstrated less intraplaque hemorrhage and ulceration.
- These findings suggest non-atherosclerotic factors may contribute to stroke risk in diabetics.
Conclusions:
- Carotid bifurcation atherosclerosis characteristics do not fully explain the elevated stroke risk in diabetic patients.
- Diabetic microangiopathy and reduced vessel compliance are potential contributing factors.
- Insulin therapy might offer protection against occlusive atherosclerosis development in diabetics.
Abstract:
Patients with diabetes mellitus are more prone to stroke than non-diabetic patients. Using Duplex ultrasound imaging of the carotid bifurcation, we have found it possible to classify atherosclerotic plaques into four groups which appear to reflect the plaque pathology. Using this classification we have found that diabetics and non-diabetics have similar ultrasound plaque type distributions in symptomatic patients. Further subdivision of the diabetic patients on the basis of their mode of diabetic control has shown that insulin treated diabetics tend to show little evidence of intraplaque haemorrhage and ulceration. These features suggest that factors other than atherosclerosis at the carotid bifurcation may be responsible for the increased stroke risk in diabetic patients. Diabetic microangiopathy and reduced vessel compliance due to medial calcification have been suggested as possible factors. Insulin treatment of diabetics may protect against the development of occlusive atherosclerosis.