A comparison of ultrasound measurements to assess carotid atherosclerosis development in subjects with and without type 2 diabetes

• Main Authors: Zinman Bernard, Hanley Anthony JG, Fenster Aaron, House Andrew A, Spence J David, Pollex Rebecca L, Harris Stewart B, Hegele Robert A
• Format: Article
• Language: English
• Published: BMC 2005-06-01
• Series: Cardiovascular Ultrasound
• Online Access: http://www.cardiovascularultrasound.com/content/3/1/15

<p>Abstract</p> <p>Background</p> <p>Subjects with type 2 diabetes are at an increased risk of vascular complications. The use of carotid ultrasound remains an attractive, non-invasive method to monitor atherosclerotic disease progression and/or response to treatment in patients with type 2 diabetes, with intima-media thickness routinely used as the gold standard to detect pathology. However, alternative measurements, such as plaque area or volume, may represent a potentially more powerful approach. Thus, the objective of this study was to compare the traditional intima-media thickness measurement against the novel total plaque volume measurement in analyzing carotid atherosclerosis development in individuals with type 2 diabetes.</p> <p>Methods</p> <p>The case-control study included 49 Oji-Cree adults with diabetes or impaired glucose tolerance, aged 21–69, and 49 sex- and age-matched normoglycemic subjects. At baseline, metabolic variables were measured, including body mass index, waist circumference, total cholesterol:high density lipoprotein ratio, plasma triglycerides, plasma glucose, and serum insulin. Carotid ultrasound measurements, 7 years later, assessed carotid arterial intima-media thickness and total plaque volume.</p> <p>Results</p> <p>At baseline, the two groups were well matched for smoking habits, hypertension, body mass index, and waist circumference. Differences were noted in baseline measurements of total cholesterol:high density lipoprotein (<it>P </it>= 0.0006), plasma triglycerides (<it>P </it>< 0.0001) and fasting glucose (<it>P </it>< 0.0001). After seven years, carotid ultrasound scans revealed that total plaque volume measurements (<it>P </it>= 0.037), but not intima-media thickness measurements, were higher in subjects with diabetes/impaired glucose tolerance compared to the normoglycemic controls. Correlation between intima-media thickness and total plaque volume was moderate. Based on our study findings, to achieve power levels >0.70 when comparing intima-media thickness measurements for diabetics versus non-diabetics, thousands of study subjects are required. For comparing total plaque volume measurements, only hundreds of study subjects are required.</p> <p>Conclusion</p> <p>The development of atherosclerotic plaque is greater in subjects with diabetes/impaired glucose tolerance. Total plaque volume appears to capture the atherosclerotic disease burden more effectively in subjects with type 2 diabetes, and would be an appropriate outcome measure for studies aimed at changing the diabetic milieu.</p>