on September 4, 2003
Published online before print September 4, 2003, doi: 10.1161/01.ATV.0000093471.58663.ED
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Submitted on July 30, 2003
Accepted on August 20, 2003
Elevated Carotid Artery Intima-Media Thickness Levels in Individuals Who Subsequently Develop Type 2 Diabetes
Kelly J. Hunt *;
From the Division of Clinical Epidemiology (K.J.H., K.W., S.M.H., M.P.S.), Department of Medicine, University of Texas Health Science Center at San Antonio; Centro de Estudios en Diabetes (D.R., C.G.V.), The American-British Cowdray Medical Center, Mexico City, Mexico; the Department of Radiology (D.H.O'L.), Tufts-New England Medical Center, Boston, Mass; and Unidades de Investigación Médica en Enfermedades Metabólicas y Epidemiología Clínica (C.G.V.), Hospital Gabriel Mancera, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
* To whom correspondence should be addressed. E-mail: huntk{at}uthscsa.edu.
Objective--We examined whether B-mode ultrasound-detected carotid artery intima-media thickness (IMT) was elevated before the onset of clinical diabetes.
Methods and Results--The study population for these analyses included 1127 nondiabetic participants, 66 prediabetic participants, and 303 diabetic participants aged 34 to 73 years who participated in the Mexico City Diabetes Study, a prospective cohort study. Common carotid artery (CCA) and internal carotid artery (ICA) IMTs were measured bilaterally by B-mode ultrasound. Age- and sex-adjusted mean ICA and CCA IMTs were both significantly higher among prediabetic individuals {0.81 mm [95% confidence interval (CI), 0.75-0.88] and 0.72 mm [95% CI, 0.69-0.75], respectively} than in individuals who remained free of diabetes [0.71 mm (95% CI, 0.69-0.72] and 0.69 mm (95% CI, 0.68-0.69), respectively]. However, after adjustment for established cardiovascular risk factors, ICA IMT, but not CCA IMT, remained significantly higher among prediabetic individuals [0.81 mm (95% CI, 0.75-0.88) and 0.71 mm (95% CI, 0.68-0.74)] than in individuals who remained free of diabetes [0.71 mm (95% CI, 0.69-0.72) and 0.69 mm (95% CI, 0.68-0.70)].
Conclusions--The present study provides direct evidence at the vascular level that atherosclerosis levels are elevated before the clinical onset of diabetes.
Key words: atherosclerosis • carotid arteries • imaging • diabetes mellitus
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