Relevance of common carotid intima-media thickness and carotid plaque as risk factors for ischemic stroke in patients with type 2 diabetes mellitus

Abstract

Background and purpose: An increase in the common carotid artery intima-media thickness (CCA-IMT) is generally considered an early marker of atherosclerosis. This cross-sectional study assessed the CCA-IMT and plaque score as vascular risk factors in patients with ischemic stroke and type 2 diabetes.

Materials and methods: Brain MR imaging and carotid ultrasonography were performed in 133 subjects with type 2 diabetes. IMT was measured at both CCAs. Differences in the variables between case and control subjects were compared statistically. To determine the independent factors related to CCA-IMT and plaque score, we performed stepwise multiple regression analysis.

Results: Sex, current smoking habit, history of hypertension, and high-density lipoprotein (HDL) levels differed significantly between the case and control groups. CCA-IMT and plaque score in patients with diabetes and acute ischemic stroke were significantly greater than in patients with diabetes who were stroke-free. The crude odds ratios suggested that CCA-IMT and plaque score are risk factors of acute ischemic stroke in patients with type 2 diabetes. However, when we adjusted for cerebrovascular risk factors, CCA-IMT and plaque score did not remain significantly associated with acute ischemic stroke.

Conclusion: Increased CCA-IMT and plaque score are associated with acute ischemic stroke in patients with type 2 diabetes. The higher CCA-IMT and plaque score found in ischemic stroke in patients with type 2 diabetes seem to be induced by cerebrovascular risk factors. Therefore, to prevent ischemic stroke in patients with type 2 diabetes, strict control of hyperglycemia, hypertension, smoking, and low HDL, together with monitoring of CCA-IMT and carotid plaque, may be important.

Fig 1.

Longitudinal scan of carotid ultrasonogram. Measurement of CCA-IMT (large arrows) at the far wall of the common carotid artery is shown. The carotid plaque (small arrows) in the distal common carotid artery is seen. The arrowhead represents carotid bifurcation.