Glycemic control and asymptomatic carotid plaque and carotid intima-media thickness

The effects of different glucose metabolic states and diabetes-controlled status on asymptomatic carotid atherosclerosis has not been well investigated. Herein, we aimed to investigate the association of different diabetes status with asymptomatic carotid plaques and carotid intima-media thickness (CIMT).

4752 participants aged over 40 years, free of stroke or myocardial infarction, from the China National Stroke Screen Survey programme were enrolled. Carotid plaque and CIMT were assessed using duplex ultrasonography. Logistic regression analysis was used to assess the relationship between diabetes status and the presence of asymptomatic carotid plaques or abnormal CIMT.

A total of 1977 (41.6%) subjects had carotid plaques and 804 (16.9%) had abnormal CIMT. In multivariate analyses, compared with normoglycemia, individuals with pre-diabetes showed significantly higher odds of asymptomatic carotid plaques (OR 1.22, 95% CI 1.03 to 1.45) and patients with diabetes also had higher odds (OR 1.66, 95% CI 1.41 to 1.92). Diabetes (OR 1.79, 95% CI 1.50 to 2.14) was associated with vulnerable plaques, while pre-diabetes was not (OR 1.17, 95% CI 0.96 to 1.43). Poorly controlled diabetes (HbA1c ≥7.5%) had higher odds of carotid plaques (OR 1.93, 95% CI 1.53 to 2.44), especially of vulnerable plaques (OR 2.03, 95% CI 1.55 to 2.67). No significant association was found between diabetes and abnormal CIMT.

Pre-diabetes and diabetes, especially poorly controlled diabetes, were associated with increased odds of asymptomatic carotid plaques. Implementing the most effective strategies to achieve optimal glycemic control is crucial for the prevention and management of atherosclerosis.