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Asymptomatic hyperglycaemia is associated with increased intimal plus medial thickness of the carotid artery
Y Yamasaki1, R Kawamori, H Matsushima
1First Department of Medicine, Osaka University School of Medicine, Japan.
Insights
Hyperglycaemic non-diabetic individuals exhibit increased carotid artery wall thickness, indicating atherosclerosis. This occurs even without traditional risk factors like hypertension or smoking, suggesting glucose intolerance itself is an atherosclerosis risk.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Vascular Biology
Background:
- Asymptomatic hyperglycaemic non-diabetic subjects have reported high coronary heart disease mortality.
- Direct evidence of atherosclerosis in these individuals has been lacking.
Purpose of the Study:
- To directly demonstrate atherosclerosis in the carotid arteries of hyperglycaemic non-diabetic subjects.
- To identify risk factors associated with increased arterial wall thickness in this population.
Main Methods:
- Non-invasive measurement of carotid artery intima-media thickness (IMT).
- Comparison of IMT between hyperglycaemic non-diabetic subjects (non-IGT and IGT), healthy males, and non-insulin-dependent diabetes mellitus (NIDDM) patients.
- Multivariate analysis to identify risk factors for IMT.
Main Results:
- Non-IGT and IGT subjects had significantly greater IMT than age-matched healthy males.
- IMT in non-IGT and IGT subjects was comparable to age-matched NIDDM patients.
- Age and systolic blood pressure were identified as risk factors for IMT.
- IMT increased linearly with the accumulation of atherogenic risks (hypertension, dyslipidaemia, smoking).
- Even without these risks, non-IGT and IGT subjects showed significantly greater IMT than controls.
Conclusions:
- Hyperglycaemic non-diabetic subjects exhibit subclinical atherosclerosis (increased carotid IMT).
- This atherosclerosis is present even in the absence of traditional risk factors.
- Glucose intolerance is an independent risk factor for atherosclerosis.
Abstract:
Atherosclerotic changes have not been demonstrated directly in asymptomatic hyperglycaemic non-diabetic subjects, although high mortality due to coronary heart disease has been reported. We measured arterial wall thickness non-invasively, in order to directly demonstrate atherosclerosis of the carotid arteries of hyperglycaemic non-diabetic subjects and to evaluate its risk factors. The thicknesses of the intimal plus medial complex (IMT) of the carotid arteries of 112 asymptomatic hyperglycaemic non-diabetic subjects (aged 22-81, 95 males and 17 females) were compared with those of 55 healthy male subjects and 211 non-insulin-dependent NIDDM male diabetic patients. The subjects were subgrouped into impaired glucose-tolerant (IGT) subjects who had a 2-h glycaemic level of more than 7.8 mmol/l, and non-IGT subjects whose 2-h glycaemic levels were within 6.7-7.7 mmol/l. Non-IGT and IGT subjects showed significantly greater IMTs than age-matched healthy males and showed no significant differences compared to age-matched NIDDM patients. Multivariate analysis demonstrated that the risk factors for IMT of non-IGT and IGT subjects were age and systolic blood pressure. According to data on the accumulation of atherogenic risks (hypertension, dyslipidaemia, and smoking), IMT increased linearly in non-IGT and IGT subjects. However, non-IGT and IGT subjects without hyperlipidaemia, hypertension, or smoking risk still had significantly greater IMT than age-matched normal males (1.019 +/- 0.063 vs 0.770 +/- 0.111 mm, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)