IJCM  Vol.9 No.3 , March 2018
Relationship between Carotid Intima-Media Thickness and Diabetes Clinical Risk Factors among Normotensive Type 2 Diabetes Mellitus among Native Black African Population
Abstract: Background: Type 2 diabetes mellitus is frequently associated with atherosclerosis with changes in the thickness of the intima-media of carotid arteries which causes increased risk of cardiovascular diseases. Cardiovascular disease is a major cause of morbidity and mortality in this group of patients. The carotid artery reflects the degree of atherosclerosis in the various vessels especially coronary arteries. Measurement of the carotid artery thickness with real time, relatively cheap and non-invasive ultrasonography method is used in monitoring atherosclerotic disease progression and response to treatment. This study is aimed at ultrasonographic evaluation of the carotid intima-media thickness (CIMT) in adult Type 2 Diabetic patients compared to non-diabetic healthy controls matched for age, gender and body mass index (BMI). And to also determine its association if any with selected clinical factors among a native Black African population. Methodology: This was a prospective case control study involving 54 adult type 2 diabetics and 54 adult non-diabetic controls. CIMT was measured at 3 segments of the extracranial carotid arteries by a 7.5 - 10 MHz linear transducer of a portable Mindray M5 ultrasound machine. Results: Among the native black African population studied, there was significant difference in CIMT of adult type 2 diabetics compared to healthy non-diabetics adults (p value = 0.012 and 0.001 on the right and left respectively). The mean carotid intima-media thickness in diabetics was 0.81 mm and 0.85 mm, while in non-diabetics it was 0.74 mm and 0.75 mm on the right and left respectively. The presence of diabetes showed independent positive correlation with CIMT (beta: 0.24, p value = 0.004). Age (beta: 0.30, p value = 0.001) and plasma cholesterol level (beta: 0.30, p value = 0.013) also had positive correlation with CIMT. Conclusion: There was statistically significant difference in carotid intima-media thickness between adult type 2 diabetics and age, sex matched non-diabetics. DM showed independent correlation with CIMT.
Cite this paper: Okafor, E. , Adekanmi, A. and Atalabi, O. (2018) Relationship between Carotid Intima-Media Thickness and Diabetes Clinical Risk Factors among Normotensive Type 2 Diabetes Mellitus among Native Black African Population. International Journal of Clinical Medicine, 9, 203-219. doi: 10.4236/ijcm.2018.93018.

[1]   (2009) Intima-Media Thickness. Wikipedia.

[2]   Shaw, J.E., Sicree, R.A. and Zimmet, P.Z. (2010) Diabetes Atlas, Global Estimates of the Prevalence of Diabetes for 2010 and 2013. Diabetes Research and Clinical Practice, 87, 4-14.

[3]   Sainani, G. and Khan, N.R. (2012) Carotid Artery Intima Media Thickness—A Correlative Study of Diabetics with Postprandial Hyperglycemia versus Controls with Euglycemia. Med Updat, 22, 298-303.

[4]   Khamseh, M., Soltani, K., Rafiee, J., Mokhber, A. and Baradaran, H. (2007) The Association of Carotid Intima-Media Thickness and Postprandial Dyslipidemia in Patients with Type 2 Diabetes. International Journal of Endocrinology and Metabolism, 5, 5-8.

[5]   Tabit, C.E., Chung, W.B., Hamburg, N.M. and Vita, J.A. (2010) Endothelial Dysfunction in Diabetes Mellitus: Molecular Mechanisms and Clinical Implications. Reviews in Endocrine & Metabolic Disorders, 11, 61-74.

[6]   Hall, V., Thomsen, R.W., Henriksen, O. and Lohse, N. (2011) Diabetes in Sub Saharan Africa 1999-2011 Epidemiology and Public Health Implications. BMC Public Health, 11, 12-18.

[7]   Akinkugbe, O.O. (1997) Non-Communicable Disease in Nigeria: Final Report of National Survey, Federal Ministry of Health and Social Services, Lagos.

[8]   Nyenwe, E., Odia, O.J., Ihekwaba, A.E., Ojule, A. and Babatunde, S. (2003) Type 2 Diabetes in Adult Nigerians: A Study of Its Prevalence and Risk Factors in Port Harcourt, Nigeria. Diabetes Research and Clinical Practice, 62, 177-185.

[9]   Pollex, R.L.R., Spence, D.J., House, A.A., Fenster, A., Hanley, A.J. and Zinman, B. (2005) A Comparison of Ultrasound Measurements to Assess Carotid Atherosclerosis Development in Subjects with and without Type 2 Diabetes. Cardiovascular Ultrasound, 3, 3-15.

[10]   Gayathri, R., Chandni, R. and Udayabhaskaran, V. (2012) Carotid Artery Intima Media Thickness in Relation with Atherosclerotic Risk Factors in Patients with Type 2 Diabetes Mellitus. Journal name, 60, 20-24.

[11]   Baldassarre, D., Amato, M., Bondioli, A., Sirtori, C.R. and Tremoli, E. (2000) Carotid Artery Intima-Media Thickness Measured by Ultrasonography in Normal Clinical Practice Correlates Well with Atherosclerosis Risk Factors. Strokestroke. Aha Journals, 31, 2426-2430.

[12]   Okeahialam, B.N., Alonge, B., Pam, S.D. and Puepet, F.H. (2011) Carotid Intima Media Thickness as a Measure of Cardiovascular Disease Burden in Nigerian Africans with Hypertension and Diabetes Mellitus. International Journal of Vascular Medicine, 2011, 327171.

[13]   Yamasaki, Y., Kodama, M., Nishizawa, H., Sakamoto, K., Matsuhisa, M. and Kajimoto, Y. (2000) Carotid Intima-Media Thickness in Japanese Type 2 Diabetic Subjects. Diabetes Care, 23, 1310-1315.

[14]   Nomura, K., Hamamoto, Y., Takahara, S., Kikuchi, O., Sachiko, H. and Hiroki, I. (2010) Relationship between Carotid Intima-Media Thickness and Silent Cerebral Infarction in Japanese Subjects with Type 2 Diabetes. Diabetes Care, 33, 168-170.

[15]   Ogbera, A.O. and Ekpebegh, C. (2014) Diabetes Mellitus in Nigeria: The Past, Present and Future. World Journal of Diabetes, 5, 905-911.

[16]   Sobngwi, E., Mauvais-Jarvis, F., Vexiau, P., Mbanya, J.C. and Gautier, J.F. (2001) Diabetes in Africans. Diabetes & Metabolism (Paris), 27, 628-634.

[17]   Gómez-Marcosa, M.A., Recio-Rodrígueza, J.I., Rodríguez-Sáncheza, E., Patino Alonsob, M.C., Magallón-Botayac, R. and Martínez-Vizcainod, V. (2011) Carotid Intima-Media Thickness in Diabetics and Hypertensive Patients. Revista Española de Cardiología, 64, 622-625.

[18]   Sarzyńska-Dlugosz, I. and Nowaczenko, M. (2001) Common Carotid Artery Intima-Media Thickness: The Role in Evaluation of Atherosclerosis Progression. Neurologia i Neurochirurgia Polska, 35, 1093-1102.

[19]   Hunt, K.J., Ken, W., David, R., Daniel, H.H. and Steve, M.S. (2003) Elevated Carotid Artery Intima-Media Thickness Levels in Individuals Who Subsequently Develop Type 2 Diabetes. Arteriosclerosis, Thrombosis, and Vascular Biology, 23, 1845-1850.

[20]   Koyasu, M., Ishii, H., Watarai, M. and Takemoto, K. (2010) Impact of Acarbose on Carotid Intima-Media Thickness in Patients with Newly Diagnosed Impaired Glucose Tolerance or Mild Type 2 Diabetes Mellitus: A One-Year, Prospective, Randomized, Open-Label, Parallel-Group Study in Japanese Adults. Clinical Therapeutics, 32, 1610-1617.

[21]   Ebrahim, S., Papacosta, O., Whincup, P., Wannamethee, G., Walker, M. and Nicolaides, A.N. (1999) Carotid Plaque, Intima Media Thickness, Cardiovascular Risk Factors, and Prevalent Cardiovascular Disease in Men and Women: The British Regional Heart Study. Stroke, 30, 841-850.

[22]   Pignoli, P. (1984) Ultrasound B-Mode Imaging for Arterial Wall Thickness Measurement. Atheroscler Review, 12, 177-184.

[23]   Simon, A. and Levenson, J. (2002) Intima-Media Thickness: A New Tool for Diagnosis and Treatment of Cardiovascular Risk. Journal of Hypertension, 20, 159-169.

[24]   Freitas, P.D., Piccinato, C.E., Martins, W.D.P. and Filho, F.M. (2008) Carotid Atherosclerosis Evaluated by Doppler Ultrasound: Association with Risk Factors and Systemic Arterial Disease. Jornal Vascular Brasileiro, 7, 298-307.

[25]   Kota, S.K., Mahapatra, G.B., Kota, S.K., Naveed, S., Tripathy, P.R. and Jammula, S. (2013) Carotid Intima Media Thickness in Type 2 Diabetes Mellitus with Ischemic Stroke. Indian Journal of Endocrinology and Metabolism, 17, 716-722.

[26]   Mitsuhashi, N., Onuma, T., Kubo, S., Takayanagi, N., Honda, M. and Kawamori, R. (2002) Coronary Artery Disease and Carotid Artery Intima-Media Thickness in Japanese Type 2 Diabetic Patients. Diabetes Care, 25, 1308-1312.

[27]   Seçil, M., Canan, A., Aytaç, G., Hasan,Ç., Ahmet, Y.G. and Oguz, D. (2005) Automated Measurement of Intima-Media Thickness of Carotid Arteries in Ultrasonography by Computer Software. Diagnostic and Interventional Radiology, 11, 105-108.

[28]   Agewall, S., Fagerberg, B., Attvall, S., Inger, W., Urbanavicius, V. and Wikstrand, J. (1995) Carotid Artery Wall Intima-Media Thickness Is Associated with Insulin-Mediated Glucose Disposal in Men at High and Low Coronary Risk. Stroke, 26, 956-960.

[29]   Butt, M., Akaria, M., Mujeeb-ur-Rehman, A.B. and Manzar, Z. (2009) Association of Common Carotid Intimal Medial Thickness (CCA-IMT) with Risk Factors of Atherosclerosis in Patients with Type 2 Diabetes Mellitus. Journal of the Pakistan Medical Association, 59, 590-593.

[30]   Irie, Y., Kubo, F., Okusu, T., Katura, T. and Yamamoto, Y. (2011) Association of Coronary Artery Stenosis with Carotid Atherosclerosis in Asymptomatic Type 2 Diabetic Patients. Journal of Atherosclerosis and Thrombosis, 18, 337-344.

[31]   Sinha, P.K., Santra, G., Saha, A. and Biswas, K. (2012) Carotid Intima-Media Thickness in Type 2 Diabetes Mellitus Patients with Cardiac Autonomic Neuropathy. Journal of Association of Physicians India, 60, 14-18.

[32]   Naroi, N.M., Yousefi, M., Nazari, H. and Ghasempoor, A. (2012) Comparing Carotid Intima-Media Thickness in Type 2 Diabetes between Patients with and without Retinopathy. Tehran University Medical Journal, 70, 40-55.

[33]   Al-Nimer, M.S.M. and Hussein, I.I. (2009) Increased Mean Carotid Intima Media Thickness in Type 2 Diabetes Mellitus Patients with Non-Blood Pressure Component Metabolic Syndrome: A Preliminary Report. International Journal of Diabetes in Developing Countries, 29, 19-22.

[34]   Charvat, J., Chlumsky, J., Zakovicova, E. and Kvapil, M. (2010) Common Carotid Artery Intima-Media Thickness Is Not Increased But Distensibility Is Reduced in Normotensive Patients with Type 2 Diabetes Compared with Control Subjects. Journal of International Medical Research, 38, 860-869.

[35]   Zhao, B., Liu, Y., Zhang, Y., Chen, Y., Yang, Z., Zhu, Y. and Zhan, W. (2012) Gender Difference in Carotid Intima-Media Thickness in Type 2 Diabetic Patients: A 4-Year Follow-Up Study. Cardiovascular Diabetology, 11, 51.

[36]   Marinchev, A. (2008) Patients with Type 2 Diabetes Mellitus Have Intima Media Thickness of Carotid Artery Wall Equal to That of a Decade Older Non-Diabetic Patients. European Congress of Endocrinology, 16, 213.

[37]   Rosfors, S., Hallerstam, S., Jensen-Urstad, K., Zetterling, M. and Carlström, C. (1998) Relationship between Intima-Media Thickness in the Common Carotid Artery and Atherosclerosis in the Carotid Bifurcation. Stroke, 29, 1378-1382.

[38]   Liu, Y., Zhan, W., Zhang, Y., Chen, Y., Lin, Y., Zhu, Y., et al. (2007) Carotid Intima-Media Thickness and Stiffness in Relation to Type 2 Diabetes in Chinese. Endocrine, 31, 289-293.

[39]   Güvener, N., Tütüncü, N., Oto, A. and Erbas, T. (2000) Major Determinants of the Carotid Intima-Media Thickness in Type 2 Diabetic Patients: Age and Body Mass Index. Endocrine Journal, 47, 525-533.

[40]   Pujia, A., Gnasso, A., Irace, C., Colonna, A. and Mattioli, P. (1994) Common Carotid Arterial Wall Thickness in NIDDM Subjects. Diabetes Care, 17, 1330-1336.

[41]   Umeh, E., Agunloye, A., Adekanmi, A. and Adeyinka, A. (2013) Ultrasound Evaluation of Intima-Media Thickness of Carotid Arteries. West African Journal of Medicine, 32, 62-67.