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Abstract

Carotid Intima-Media Thickness, Ankle-Arm Index, and Inflammation Profile in Mexican Patients with Early and Late Onset Type 2 Diabetes

VOLUME 67 - NUMBER 4 / July - August (Original articles)

Alicia Contreras-Rodríguez, Radiodiagnostic Service, UMAE Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México
Rita A. Gómez-Díaz, Department of Medical Investigation in Clinical Epidemiology, UMAE Hospital de Especialidades, Mexico City, Mexico; School of Medicine, Instituto Politécnico Nacional, Mexico City, Mexico
Janet Tanus-Hajj, Radiodiagnostic Service, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México
Juan O. Talavera, Medical Research Unit in Clinical Epidemiology, UMAE Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F., México
Rafael Mondragón-González, Department of Medical Investigation in Clinical Epidemiology, UMAE Hospital de Especialidades, Mexico City, Mexico; School of Medicine, Instituto Politécnico Nacional, Mexico City, Mexico
Niels H. Wacher, Department of Medical Investigation in Clinical Epidemiology, UMAE Hospital de Especialidades, Mexico City, Mexico; School of Medicine, Instituto Politécnico Nacional, Mexico City, Mexico

Background: Type 2 diabetes is strongly linked to an increased incidence of cardiovascular outcomes. Carotid artery intima-media thickness and ankle-arm index are non-invasive complementary measures as subclinical markers of atherosclerosis. Objective: To evaluate the association of carotid intima-media thickness, ankle-arm index, and inflammation profile in Mexican patients with early- and late-onset type 2 diabetes mellitus. Material and Methods: We included 145 subjects at an academic medical center: 77 patients with early-onset (< 40 years of age) and 33 patients with late-onset (≥ 40 years) type 2 diabetes mellitus, and 35 healthy volunteers. Clinical history, anthropometrics, blood chemistry, lipids profile, glycosylated hemoglobin A1c, cytokines, and high-sensitivity C-reactive protein were determined; carotid and lower limb ultrasound were taken. Groups were compared with ANOVA or Kruskal-Wallis, Student’s t or Mann-Whitney U. Spearman or Pearson correlation and logistic regression analysis were used. Results: There were anthropometric and biochemical differences between the three groups. Concentrations of interleukin-1β, -4 and -6 were significantly higher in patients with late versus early onset diabetes. There were differences in carotid intima-media thickness and ankle-arm index between early and late onset. Age, body mass index, high-density lipoprotein cholesterol, high-sensitivity C-reactive protein, waist circumference, and glycosylated hemoglobin A1c showed direct correlation with carotid intima-media thickness, while ankle-arm index showed inverse correlation with blood pressure, glycosylated hemoglobin A1c, time with disease, age at onset, triglycerides, and fibrinogen. Multivariate analysis showed an association between carotid intima-media thickness and disease duration; ankle-arm index with disease duration and high-sensitivity C-reactive protein; while only body mass index associated with end diastolic flow velocity. Conclusions: Our findings suggest that carotid intima-media thickness and ankle-arm index are associated with inflammation markers and could be included in the evaluation of type 2 diabetes mellitus patients, according to disease onset and duration. There are important differences in interleukin concentrations between early- and late-onset type 2 diabetes mellitus. Additionally, measurement of high-sensitivity C-reactive protein is suggested in patients with abnormal ankle-arm index.

Keywords: Type 2 diabetes. cIMT. Ankle-arm index. Inflammation marker. Early onset.

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