Glucose-related arterial stiffness and carotid artery remodeling: A study in normal subjects and type 2 diabetes patients

Abstract

Context: Hyperglycemia is associated with a higher carotid intima-media thickness (IMT); however, it is not established whether this increase reflects early atherosclerotic changes or adaptive remodeling responding to hyperglycemia-induced alteration in mechanical properties of the arterial wall. Objective: The aims of this study were to compare carotid geometry and circumferential wall stress between patients with type 2 diabetes mellitus (T2DM) and healthy controls and to evaluate the associations between chronic glucose exposure and measures of arterial structure and function. Design and Setting: This was a case-control and cross-sectional study within institutional practice. Participants: Participants included 133T2DMpatients free of cardiovascular complications and 133 healthy controls with normal glucose metabolism, matched for sex, age, and body mass index. Main Outcome Measures: Common carotid artery (CCA) IMT, luminal diameter, wave speed, and local pulse pressure (PP) were evaluated. Results: As compared with controls, T2DM patients had higher (P < .0001) CCA IMT (640 ± 81 vs 709 ± 118 μm), luminal diameter (6.12 ± 0.67 vs 6.69 ± 0.56 mm), and brachial PP (47 ± 7 vs 57 ± 12mmHg), whereas luminal radius to IMT ratio (4.8 ± 0.7 vs 4.8 ± 0.8, P = .57) and circumferential wall stress (49.0 ± 8.3 vs 50.6 ± 10.3 kPa, P =.26) were comparable between the 2 groups. In T2DM patients, glycosylated hemoglobin was independently related to CCA wave speed and local PP, but not to IMT that was determined by age, local PP, and luminal diameter. Conclusions: This study suggests that the increase in IMT associated with a higher glucose exposure might reflect adaptive remodeling counteracting an increase in pulsatile strain and preventing increase in circumferential wall stress caused by luminal enlargement of stiff arteries.