Albuminuria and Carotid Atherosclerosis in Type 1 Diabetes Evaluated Using Three-Dimensional Vascular Ultrasound
Luis F Ferreira-Divino1, Christina G Poulsen1, Viktor Rotbain Curovic1
1Steno Diabetes Center Copenhagen, Herlev, Denmark.
Insights
Individuals with type 1 diabetes exhibit increased carotid plaque volume compared to healthy individuals. Higher albuminuria levels correlate with greater carotid plaque burden in type 1 diabetes patients.
Area of Science:
- Cardiovascular Medicine
- Diabetology
- Vascular Ultrasound Imaging
Background:
- Albuminuria signifies elevated cardiovascular disease (CVD) and mortality risk in type 1 diabetes.
- Carotid atherosclerosis is a key indicator of CVD risk.
Purpose of the Study:
- To compare carotid atherosclerosis between type 1 diabetes patients and healthy controls.
- To evaluate the association between albuminuria and carotid atherosclerosis in type 1 diabetes.
Main Methods:
- A cross-sectional study involving 290 type 1 diabetes patients and 60 healthy controls.
- Three-dimensional vascular ultrasound (3DVUS) measured carotid total plaque volume (TPV); two-dimensional vascular ultrasound (2DVUS) measured carotid maximal plaque thickness (cPTmax).
- Ordinal logistic regression analyzed TPV and cPTmax in relation to albuminuria categories.
Main Results:
- Type 1 diabetes patients showed significantly higher median TPV (28 mm³ vs. 9 mm³) and cPTmax (14 mm vs. 11 mm) than controls.
- Higher albuminuria levels in type 1 diabetes patients were independently associated with increased TPV and cPTmax.
- Severely increased albuminuria was linked to higher TPV compared to normal albuminuria.
Conclusions:
- Type 1 diabetes patients have greater carotid plaque volume than healthy individuals, irrespective of other risk factors.
- Elevated albuminuria levels are directly associated with increased carotid plaque burden in type 1 diabetes.
- Vascular ultrasound effectively quantifies atherosclerosis in type 1 diabetes and its relation to albuminuria.
Introduction:
Presence of albuminuria is associated with high risk of cardiovascular disease (CVD) and premature mortality in individuals with type 1 diabetes. We aimed to investigate carotid atherosclerosis in individuals with type 1 diabetes compared with healthy controls and assess the association between presence of albuminuria and carotid atherosclerosis in type 1 diabetes using three-dimensional vascular ultrasound (3DVUS) and two-dimensional vascular ultrasound (2DVUS).
Materials & Methods:
Cross-sectional study including 350 individuals, 290 with type 1 diabetes and 60 healthy controls. Carotid total plaque volume (TPV) was measured using 3DVUS and carotid maximal plaque thickness (cPTmax) using 2DVUS. TPV and cPTmax were highly skewed and analysed in four categories using unadjusted and adjusted ordinal logistic regression models. Albuminuria categories were defined by the highest persistent urinary albumin-creatinine ratio level recorded in each participant's medical history.
Results:
In the total cohort, 56% were men and mean (SD) age was 56 (14) years. Among the individuals with type 1 diabetes, 110 (38%) had normal-, 124 (43%) moderately increased- and 56 (19%) severely increased albuminuria. Individuals with type 1 diabetes had higher median [IQR] TPV of 28 [0-144] mm3 and cPTmax (14 [0-21] mm) compared to healthy controls (9 [0-54] mm3, 11 [0-17] mm). In adjusted ordinal logistic regression models, individuals with type 1 diabetes were more likely to be in a higher TPV category than healthy controls (0.82, 95% CI [0.16, 1.48], p = 0.015), whereas no difference was demonstrated for cPTmax. Among individuals with type 1 diabetes, presence of severely increased albuminuria was associated with being in a higher TPV category than normal albuminuria (1.40, 95% CI [0.61, 2.21], p < 0.001) after adjustment, whereas no difference was seen for cPTmax categories. Higher current albuminuria was associated with being in a higher TPV (p = 0.002) and cPTmax (p = 0.047) category after adjustment.
Conclusion:
Participants with type 1 diabetes had higher carotid TPV than healthy controls independent of other risk factors and higher levels of albuminuria were associated with higher carotid TPV and cPTmax in type 1 diabetes.
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