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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 13  |  Issue : 2  |  Page : 79-82

The study of carotid intima-media thickness in prediabetes and its correlation with cardiovascular risk factors


Department of Medicine, JNMC, Wardha, Maharashtra, India

Date of Web Publication23-Nov-2018

Correspondence Address:
Dr. Hirday Pal Singh Bhinder
Department of Medicine, JNMC, Sawangi, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_58_18

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  Abstract 


Background: Metabolic syndrome, insulin resistance, so-called prediabetes (impaired glucose tolerance and impaired fasting glucose), and overt type 2 diabetes are all associated to more extensive and even premature atherosclerosis both in the coronary and the carotid arteries. They are all found to be associated with cardiovascular risk factors. Carotid intima-media thickness (CIMT) is considered surrogate marker of atherosclerosis. Early and cheap method of detecting atherosclerosis rules out the burden of cardiovascular disease in society. Materials and Methods: This was a prospective case–control study of CIMT in patients having prediabetes. A total of 100 patients of prediabetes and equal number of age- and sex-matched controls were enrolled. Bilateral assessment of IMT was done in common carotid artery. Statistical analysis was done using descriptive statistics and inferential statistics, using Chi-square test, odd's ratio, Pearson's correlation coefficient and multiple regression analysis. The software used in this analysis was SPSS version 17.0 and GraphPad Prism version 5.0. P <0.05 was considered as a level of statistical significance. Results: About 56% of cases were male and 44% were females, and in controls, 58% were male and 42% were female. Mean age of cases was 45.06 ± 13.08 and that of controls was 44.15 ± 13.64. Mean value of CIMT for cases (0.79 ± 0.06 mm) was higher than for controls (0.72 ± 0.02 mm). The difference between the two groups was found to be statistically significant (P < 0.05, S). Conclusion: Mean CIMT was higher in prediabetes group in comparison to controls; however, in both groups, CIMT was not in the abnormal range. Body mass index and waist-hip ratio were significantly higher in prediabetes as compared to controls. Systolic and diastolic blood pressures were significantly higher in prediabetes as compared to controls. Total cholesterol, low-density lipoprotein (LDL), triglyceride (TG), and very LDL were significantly higher in prediabetes, and high-density lipoprotein (HDL) was significantly lower in prediabetes as compared to controls. According to this model, among cases, serum Tg and age were found to be responsible for the maximum variability of CIMT.

Keywords: Cardiovascular disease, carotid intima-media thickness, metabolic syndrome


How to cite this article:
Bhinder HP, Kamble T K. The study of carotid intima-media thickness in prediabetes and its correlation with cardiovascular risk factors. J Datta Meghe Inst Med Sci Univ 2018;13:79-82

How to cite this URL:
Bhinder HP, Kamble T K. The study of carotid intima-media thickness in prediabetes and its correlation with cardiovascular risk factors. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2018 Dec 16];13:79-82. Available from: http://www.journaldmims.com/text.asp?2018/13/2/79/246012




  Introduction Top


Diabetes in its early stage is categorized as prediabetes[1] and is a leading risk factor for diabetes. An individual is considered to be prediabetes if he/she has a blood glucose level that is above normal but below the diagnostic threshold for diabetes mellitus. The prevalence of prediabetes is also increasing worldwide. Seventy-nine million people had prediabetes in the United States as per the American Diabetes Association – January 26, 2011.[2] In India, 77.2 million people had prediabetes, in 2011.[3]

Studies implicate glucose per se for the increased cardiovascular risk, and an abnormality of glucose regulation rarely occurs in isolation. Rather, it tends to cluster with other known cardiovascular risk factors. This clustering of impaired fasting glucose with hypertension, visceral obesity, and atherogenic dyslipidemia (low high-density lipoprotein [HDL] cholesterol or high triglycerides [TGs]) is known as metabolic syndrome. Pro-inflammatory and prothrombotic factors are frequently elevated in metabolic syndrome and are also associated with impaired glucose tolerance.[4] [Table 1]
Table 1: Baseline characteristics of the study population

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The presence of metabolic syndrome increases the risk of atherosclerotic cardiovascular disease and the risk of developing type 2 diabetes.[5]

The wall thickness of the carotid artery measured as intima-media thickness (IMT) is an indicator for the early carotid atherosclerosis. Various others have previously shown that an increased common carotid artery (CCA) IMT is associated with the established risk factors for cardiovascular disease, coronary atherosclerosis, and cardiovascular morbidity.[6]

Prevention of cardiovascular disease in prediabetes before the onset of diabetes is likely to be the most fruitful method of mitigating some of the well-known adverse consequences of diabetes. Keeping in view risk of complications of prediabetes, the study of carotid IMT (CIMT) and other cardiovascular risk factors in prediabetes was undertaken.

The study of CIMT in prediabetes and its correlation with cardiovascular risk factors was conducted in AVBRH, Sawangi (Meghe) Wardha.

Aims and objectives

  1. To study CIMT in prediabetes
  2. To correlate CIMT with cardiovascular risk factors.



  Materials and Methods Top


Study design

This study was conducted at the Department of Medicine, Acharya Vinoba Bhave Rural Hospital. This was a cross-sectional case–control study. The study protocol was approved by the Ethical Review Committee, and written informed consent was obtained from the study participants.

Study settings

This is a cross-sectional case–control observational study from September 2016 to September 2016. The study protocol was approved by the Ethical Review Committee, and written informed consent was obtained from the study participants.

Inclusion criteria

Cases – we have included patients with prediabetes, fulfilling the following criteria:

  • Fasting blood glucose level is between 110 mg/dl and 125 mg/dl (World Health Organization [WHO] 1999)
  • Two-hour plasma glucose level after 75-g oral glucose tolerance test (OGTT) is between 140 and 199 mg/dL (WHO 1999)
  • Controls – age- and sex-matched controls were included in the study.


Exclusion criteria

  • Not consenting patients
  • Patients with Type I/Type II diabetes mellitus patients
  • Smokers and alcoholics.


Methods

All participants' demographic records and information about physical activity, any kinds of addictions, and history of hypertension, computer-aided design, and dyslipidemia were collected.

Criteria for the diagnosis of prediabetes (WHO 1999)

  1. Fasting plasma glucose (FPG) between 110 and 125 mg/dl. Fasting is defined as no caloric intake for at least 8 h or
  2. Two-hour OGTT, plasma glucose, between 140 and 199 mg/dl. The OGTT should be performed using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.


Anthropometric measurements and clinical parameters

Anthropometric features including weight, height, body mass index (BMI), waist circumference (WC), and hip circumference were measured by standard method.

Biochemical parameters estimation

Estimation of glucose in plasma – FPG was estimated by glucose oxidase/peroxidase method using the machine Robonik Semiautomatic Chemical Analyser.

Specimen collection – after 8 h of fast, participants venous sample was taken from the antecubital vein and collected in sugar bulb-containing sodium fluoride as anticoagulant. This was done to prevent glycolysis and better separation of serum or plasma as soon as possible.

Estimation of serum total cholesterol – serum total cholesterol was estimated using liquid stable CHOD–PAP method using machine Robonik Semiautomatic Chemical Analyser.

Estimation of serum TG – serum TGs were estimated using liquid stable glycerol phosphate oxidase – PAP method using machine Robonik Semiautomatic Chemical Analyser.

Estimation of serum HDL – serum HDL was estimated by direct enzymatic method using machine Robonik Semiautomatic Chemical Analyser.

LDL was calculated using the Friedewald formula: LDL cholesterol = (Total Cholesterol − HDL Cholesterol − TGs/5).

VLDL was calculated by dividing TG level by 5.

Carotid intima-media thickness

CIMT was measured by Aloka ProSound with linear probe of 5–7 HZ in B-mode in AVBRH.

Principle

Intima-media thickness is defined as the distance between the leading edge of the first echogenic line (lumen-intimal interface) and the second echogenic line (media-adventitia interface) of the far wall. Shows intima-media thickness. IMT is measured as the distance between lumen-intima (yellow-line) and media-adventitia (pink-line) interfaces.

Procedure

Three measurements were taken at 0.5, 1, and 2 cm below the carotid bifurcation of the CCA on each side and their average was considered. For better reproducibility of IMT, measurement values from right to left CCA were combined.

Variables and measurements

  1. According to the WHO (1999), FPG or 2 h OGTT for prediabetic participants was taken between 110 and 125 mg/dL and 140–199 mg/dL, respectively
  2. The WHO values for waist-hip ratio of <0.90 in males and <0.85 in females were considered as normal whereas a waist-hip ratio of ≥0.90 in males and ≥0.85 in females was considered abnormal
  3. According to the WHO: categories of BMI for Asia-Pacific Region
  4. Blood pressure classification – Joint National Committee 7. We have taken systolic blood pressure <120 mmHg as normal and diastolic blood pressure <80 mmHg as normal
  5. National Cholesterol Education Program ATP III Classification of Lipid Levels
  6. CIMT measurement: the latest ESH/ESC hypertension guidelines (2013) CIMT >0.9 mm was considered abnormal which has been confirmed as a marker of asymptomatic organ damage.


Statistical analysis

In this cross-sectional, statistical analysis was done using descriptive statistics and inferential statistics, using Chi-square test, odd's ratio, Pearson's correlation coefficient, and multiple regression analysis. The software used in this analysis was SPSS version 17.0 (SPSS Inc., IL, Chicago) and GraphPad Prism version 5.0 (La Jolla, CA, USA). P < 0.05 is considered as a level of significance.


  Results Top


In our study dyslipidemia, hypertension CIMT was found to be higher in prediabetes group in comparison to controls [Table 1].

Results of the study according to each variable are as follows:

  • Mean age of cases was 45.06 ± 13.08 and that of controls was 44.15 ± 13.64. There was no significant age difference between both the groups (P > 0.05). This means that age-matched controls were included in the study
  • Gender – cases include 56% of males and 44% of females. Controls include 58% of males and 42% of females. There was no statistically significant difference found in gender of participants in both the groups (P > 0.05). This means that sex-matched controls were included in the study
  • Family history of diabetes mellitus – 43% of cases had a family history of diabetes mellitus and 36% of controls had a family history of diabetes mellitus. There was no statistically significant difference found (P > 0.05)
  • BMI – in our study, mean BMI for prediabetes group was 23.01 ± 1.65 and mean BMI for controls was 21.33 ± 1.92 (P = 0.0001, S, P < 0.05)
  • Waist-hip ratio in males – in our study, mean of waist-hip ratio in prediabetic males was 0.88 ± 0.06, and in control, male participants were 0.81 ± 0.06.(P = 0.0001 S, P < 0.05)
  • Waist-hip ratio in females – in our study, mean of waist-hip ratio in prediabetic females was 0.85 ± 0.04, and in controls, male was 0.79 ± 0.06 (P = 0.0001 S, P < 0.05)
  • WC – in our study, mean WC was 88.89 ± 6.55 in prediabetes group and 81.65 ± 6.83 in control group (P = 0.0001 S, P < 0.05)
  • Systolic blood pressure – in our study, mean systolic blood pressure in prediabetes group was 132.20 ± 18.08 and in control group was 121.32 ± 15.37 (P = 0.007 S, P < 0.05)
  • Diastolic blood pressure – in our study, mean for diastolic blood pressure in prediabetes group was 85.44 ± 10.69 and mean for diastolic blood pressure for controls was 79.12 ± 9.04.(P = 0.0002, S, P < 0.05)
  • Total cholesterol – in our study, mean for total cholesterol level in prediabetes was 197.62 ± 23.85 and mean for total cholesterol in controls was 176.81 ± 21.64 (P = 0.0001 S, P < 0.05)
  • LDL – in our study, mean for LDL in prediabetes was 101.42 ± 15.84 and mean in controls was 92.29 ± 14.90 (P = 0.0001 S, P < 0.05)
  • HDL in males – in our study, mean of HDLs in prediabetic males was 40.33 ± 5.11, and in controls, mean HDL was 45.43 ± 5.27 (P = 0.0001 S, P < 0.05)
  • HDLs in females – In our study, mean of HDLs in prediabetic females was 42.06 ± 6.21 and in controls was 46.88 ± 4.89 (P = 0.0001; S, P < 0.05)
  • Very LDL – in our study, mean for VLDL in prediabetes was 40. ±63.5.80, and mean for VLDL in controls was 34.01 ± 2.89.(P = 0.0001 S, P < 0.05)
  • TGs – in our study, mean for TGs in prediabetes was 158.62 ± 28.45 and mean for TGs in normal participants was 139.17 ± 13.18 (P = 0.0001 S, P < 0.05)
  • CIMT – mean CIMT in prediabetes group was 0.79 ± 0.06 and controls were 0.72 ± 0.02 (P = 0.0001, S, P < 0.05)
  • Multiple regression analysis – on multiple regression analysis in cases, serum Tg and age were found to be significantly associated with CIMT.
[Table 2]
Table 2: Multiple regression analysis in cases

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Based on the results, we concluded that systolic blood pressure, diastolic blood pressure, BMI, dyslipidemia, and CIMT were higher in prediabetic group.

Limitations

A limitation of the study was the relatively small sample size cases (n = 100) and controls (n = 100). For this reason, these findings cannot be generalized.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wen CP, Cheng TY, Tsai SP, Hsu HL, Wang SL. Increased mortality risks of pre-diabetes (impaired fasting glucose) in Taiwan. Diabetes Care 2005;28:2756-61.  Back to cited text no. 1
    
2.
Centers for Disease Control and Prevention. 2011 National Diabetes Fact Sheet: Diagnosed and Undiagnosed Diabetes in the United States, All Ages, 2010. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion; 2011.  Back to cited text no. 2
    
3.
Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: Phase I results of the Indian Council of Medical Research-INdia DIABetes (ICMR-INDIAB) study. Diabetologia 2011;54:3022-7.  Back to cited text no. 3
    
4.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult treatment panel III). JAMA 2001;285:2486-97.  Back to cited text no. 4
    
5.
Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002;288:2709-16.  Back to cited text no. 5
    
6.
Suurküla M, Agewall S, Fagerberg B, Wendelhag I, Widgren B, Wikstrand J, et al. Ultrasound evaluation of atherosclerotic manifestations in the carotid artery in high-risk hypertensive patients. Risk intervention study (RIS) group. Arterioscler Thromb 1994;14:1297-304.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2]



 

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