Carotid intima-media thickness and arterial stiffness in relation to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes

Jussi Inkeri^{1

2}, Anniina Tynjälä^{2

3

4}, Carol Forsblom^{2

3

4}, Ron Liebkind⁵, Turgut Tatlisumak^{5

6

7}, Lena M Thorn^{2

4

8}, Per-Henrik Groop^{9

10

11

12}, Sara Shams^{13

14

15}, Jukka Putaala⁵, Juha Martola¹, Daniel Gordin^{2

3

4

16}; FinnDiane Study Group

Affiliations

¹ HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
² Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
³ Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁴ Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
⁵ Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁶ Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁹ Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland. per-henrik.groop@helsinki.fi.
¹⁰ Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. per-henrik.groop@helsinki.fi.
¹¹ Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland. per-henrik.groop@helsinki.fi.
¹² Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia. per-henrik.groop@helsinki.fi.
¹³ Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
¹⁴ Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
¹⁵ Department of Radiology, Stanford University, Stanford, CA, USA.
¹⁶ Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.

PMID: 33743083
PMCID: PMC8187193
DOI: 10.1007/s00592-021-01678-x

Carotid intima-media thickness and arterial stiffness in relation to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes

Jussi Inkeri et al. Acta Diabetol. 2021 Jul.

. 2021 Jul;58(7):929-937.

doi: 10.1007/s00592-021-01678-x. Epub 2021 Mar 20.

Authors

Affiliations

¹ HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
² Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
³ Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁴ Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
⁵ Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁶ Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
⁷ Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁸ Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁹ Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland. per-henrik.groop@helsinki.fi.
¹⁰ Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. per-henrik.groop@helsinki.fi.
¹¹ Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland. per-henrik.groop@helsinki.fi.
¹² Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia. per-henrik.groop@helsinki.fi.
¹³ Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
¹⁴ Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
¹⁵ Department of Radiology, Stanford University, Stanford, CA, USA.
¹⁶ Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.

PMID: 33743083
PMCID: PMC8187193
DOI: 10.1007/s00592-021-01678-x

Abstract

Aims: To determine if arterial functional and structural changes are associated with underlying cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes.

Methods: We enrolled 186 individuals (47.8% men; median age 40.0, IQR 33.0-45.0 years) with type 1 diabetes (median diabetes duration of 21.6, IQR 18.2-30.3 years), and 30 age- and sex-matched healthy controls, as part of the Finnish Diabetic Nephropathy (FinnDiane) Study. All individuals underwent a biochemical work-up, brain magnetic resonance imaging (MRI), ultrasound of the common carotid arteries and arterial tonometry. Arterial structural and functional parameters were assessed by carotid intima-media thickness (CIMT), pulse wave velocity and augmentation index.

Results: Cerebral microbleeds (CMBs) were present in 23.7% and white matter hyperintensities (WMHs) in 16.7% of individuals with type 1 diabetes. Those with type 1 diabetes and CMBs had higher median (IQR) CIMT 583 (525 - 663) μm than those without 556 (502 - 607) μm, p = 0.016). Higher CIMT was associated with the presence of CMBs (p = 0.046) independent of age, eGFR, ApoB, systolic blood pressure, albuminuria, history of retinal photocoagulation and HbA_1c. Arterial stiffness and CIMT were increased in individuals with type 1 diabetes and WMHs compared to those without; however, these results were not independent of cardiovascular risk factors.

Conclusions: Structural, but not functional, arterial changes are associated with underlying CMBs in asymptomatic individuals with type 1 diabetes.

Keywords: Arterial tonometry; Carotid intima-media thickness; Cerebral microbleed; Magnetic resonance imaging.

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Conflict of interest statement

D.G. Lecture or advisory honoraria: AstraZeneca, Boehringer Ingelheim, Delta Medical Communications, Fresenius, GE Healthcare, Novo Nordisk. Support to attend medical meetings: CVRx., Sanofi Aventis. J.M. Lecture Honoria Santen. P.-H.G. has received lecture honoraria from AstraZeneca, Boehringer Ingelheim, Eli Lilly, Elo Water, Genzyme, Medscape, Merck Sharp & Dohme (MSD), Mundipharma, Novartis, Novo Nordisk, PeerVoice, Sanofi, SCIARC and is an advisory board member of AbbVie, Bayer, Boehringer Ingelheim, Eli Lilly, Janssen, Medscape, MSD, Novartis, Novo Nordisk and Sanofi. No other potential conflicts of interest relevant to this article were reported.

Figures

**Fig. 1**
Carotid intima-media thickness (μm) by number of cerebral microbleeds in individuals with type 1 diabetes. Individuals with type 1 diabetes subdivided into three groups based on the number of cerebral microbleeds (zero [n = 142], one to two [n = 32], more than two [n = 12]) with a CIMT of 556 (502–607) μm vs. 578 (513–640) μm vs. 634 (533–737) μm, p = 0.028, respectively

See this image and copyright information in PMC

References

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Carotid intima-media thickness and arterial stiffness in relation to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes

Affiliations

Carotid intima-media thickness and arterial stiffness in relation to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

Research Materials

Miscellaneous