Glucose-Related Arterial Stiffness and Carotid Artery Remodeling: A Study in Normal Subjects and Type 2 Diabetes Patients.

Context Hyperglycemia is associated with a higher carotid intima-media thickness (IMT), however it is not established whether this increase reflects early atherosclerotic changes or adaptive remodeling responding to hyperglycemia-induced alteration in mechanical properties of the arterial wall. Objective Aim of this study was to compare carotid geometry and circumferential wall stress between patients with type 2 diabetes mellitus (T2DM) and healthy controls, and to evaluate the associations between chronic glucose exposure and measures of arterial structure and function. Design Case-control and cross-sectional study Setting Institutional practice Participants One hundred thirty-three T2DM patients free of cardiovascular complications and 133 healthy controls with normal glucose metabolism, matched for sex, age, body mass index Main Outcome Measures Common carotid artery (CCA) IMT, luminal diameter, wave speed (WS) and local pulse pressure (PP) Results As compared to controls, T2DM patients had higher (P<0.0001) CCA IMT (640±81 vs 709±118 μ m), luminal diameter (6.12±0.67 vs 6.69±0.56 mm) and brachial PP (47±7 vs 57±12 mmHg), whereas luminal radius to IMT ratio (4.8±0.7 vs 4.8±0.8, P=0.57) and circumferential wall stress (49.0±8.3 vs 50.6±10.3 kPa, P=0.26) were comparable between the two groups. In T2DM patients, glycosylated hemoglobin was independently related to CCA WS and local PP, but not to IMT that was determined by age, local PP and luminal diameter. Conclusions This study suggests that increase in IMT associated with a higher glucose exposure might reflect an adaptive remodeling counteracting raise in pulsatile strain and preventing increment in circumferential wall stress caused by luminal enlargement of stiff arteries.