Carotid Intima Media Thickness and Plaque in Type 2 Diabetes without Cardiovascular Disease
Prapasri Eiamthong MD*, Chaicharn Deerochanawong MD**
Affiliation : * Department of Radiology, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand ** Division of Endocrinology, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
Background : Type 2 diabetes mellitus (T2DM) constitutes a major public health care problem in Thailand and worldwide.
Many complications can occur, especially atherosclerotic change in the vessels leading to coronary, cerebrovascular and
peripheral arterial disease.
Objective : Using B-mode ultrasound (US), to study the carotid intima media thickness (IMT) and carotid plaque in patients
with type 2 DM without cardiovascular disease, and to identify the factors that are related to plaque formation.
Material and Method: This was a prospective cross-sectional study, conducted in Rajavithi Hospital between September
2016 and February 2017, of 150 patients with type 2 DM who had no history of symptomatic coronary, cerebrovascular or
peripheral arterial disease. Measurement of carotid IMT and carotid plaque was performed by a single radiologist.
Results : There were 150 patients, 68.7% of whom were women and 31.3% men, and their mean age was 66 years (48 to 79
years old). Mean carotid IMT of the right and left common carotid artery were 0.79+0.26 mm and 0.83+0.28 mm, respectively.
Plaque levels at the right and left carotid bulb were 1.46+0.69 mm and 1.37+0.61 mm respectively, while plaque levels at the
right and left internal carotid artery were 1.24+2.88 mm and 1.03+0.45 mm, respectively. A total of 87.3% of subjects were
associated with hypertension and 96.0% with dyslipidemia during medical treatment. A rate of less than 50% carotid stenosis
was found in 26.7% of the patients, while those with more than 50.0% carotid stenosis accounted for 10.0%. There was no
gender-related difference in carotid plaque formation in this study. The rate of positive carotid plaque was associated with the
duration of DM (p-value = 0.004), and serum triglyceride levels (p-value = 0.004). Multivariate regression analysis
indicated that significant carotid plaque was associated with receiving ACEI/ARB for treatment of hypertension (p-value =
0.029).
Conclusion : Carotid atherosclerosis was found in 36.7% of cases. Most of the patients in the present study were normal or
had no significant carotid atherosclerosis. There were varying degrees of vessel stenosis ranging between less than 50.0%
stenosis and 50.0 to 70.0%. Ten percent of patients had more than 50.0% stenosis and received aspirin to prevent future
vascular events.
Keywords : Carotid plaque, Carotid IMT, B-mode ultrasound, Type 2 DM, Angiotensin- converting enzyme inhibitors (ACEI), Angiotensin II receptor blocker (ARB)
