The influence of carotid plaque on carotid artery stiffness indicators in hypertensive patients with and without accompanying type 2 diabetes
DOI:
https://doi.org/10.14739/2409-2932.2024.1.297229Keywords:
atherosclerosis, local arterial stiffness, hypertension, diabetes mellitusAbstract
Aim. To compare the elastic properties of the common carotid arteries (CCA) in patients with stage II hypertension (HTN) depending on the presence of diabetes mellitus (DM) and atherosclerotic plaque (ASP) <50 % of carotid arteries (CA).
Materials and methods. The study included 80 patients with stage II HTN, 43 of them without type 2 DM, 37 with type 2 DM, average age – 57.7, 55.3 % men. Basic anthropometric data, laboratory indicators of lipid and carbohydrate metabolism, creatinine, data of daily blood pressure monitoring, echocardiography, intima-media thickness, local stiffness indicators: artery diameter, distensibility, the distensibility coefficient (DC), and compliance coefficient (CC), stiffness indices α, β, local pulse wave velocity (PWV), pressure and augmentation index (using radiofrequency-based technologies) were studied. Statistical analysis was performed; the probability of differences is at the level of p < 0.05.
Results. The prevalence of ASP in the carotid basin in the group of patients with HTN without DM was 51.1 %, with DM – 54.0 % (p = 0.79). While comparing the elastic properties of CCA of patients without ASP, no reliable similarities were found in the studied indicators. In patients with HTN, accompanying type 2 DM with ASP, the diameter of the CCA was significantly larger by 11.8 % (p = 0.03), and the CC was also higher by 23.6 % (p = 0.049) than in patients with HTN without DM. In patients with HTN with and without DM the limit levels for the intima-media thickness of the left CCA associated with the presence of atheroma were determined, however, the comparison of the areas under the ROC curves did not reveal a statistical difference in the cut-off values in the studied groups (р = 0.681).
Conclusions. A feature of CCA remodeling in HTN patients with DM at the stage of ASP presence should be considered a more substantial increase in the diameter of the CCA with preservation of the distensibility of the plaque-free vascular wall. The addition of a second factor (DM) to one risk factor (HTN) is not accompanied by a further statistically significant increase in IMT as a mandatory prerequisite for the appearance of ASP.
References
Gan W, Bragg F, Walters RG, Millwood IY, Lin K, Chen Y, et al. Genetic Predisposition to Type 2 Diabetes and Risk of Subclinical Atherosclerosis and Cardiovascular Diseases Among 160,000 Chinese Adults. Diabetes. 2019;68(11):2155-64. doi: https://doi.org/10.2337/db19-0224
Wang Z, Yang T, Fu H. Prevalence of diabetes and hypertension and their interaction effects on cardio-cerebrovascular diseases: a cross-sectional study. BMC Public Health. 2021;21(1):1224. doi: https://doi.org/10.1186/s12889-021-11122-y
Staef M, Ott C, Kannenkeril D, Striepe K, Schiffer M, Schmieder RE, et al. Determinants of arterial stiffness in patients with type 2 diabetes mellitus: a cross sectional analysis. Sci Rep. 2023;13(1):8944. doi: https://doi.org/10.1038/s41598-023-35589-4
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. J Hypertens. 2018;36(10):1953-2041. doi: https://doi.org/10.1097/HJH.0000000000001940
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-70. doi: https://doi.org/10.1093/ehjci/jev014
Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein N, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34(4):290-6. doi: https://doi.org/10.1159/000343145
Bohun AO. [Dependence of local carotid arterial stiffness on the presence of atherosclerotic plaque in the carotid basin in hypertensive patients]. Zaporozhye medical journal. 2024;26(1):11-8. Ukrainian. doi: https://doi.org/10.14739/2310-1210.2024.1.293501
Kadoglou NPE, Moulakakis KG, Mantas G, Kakisis JD, Mylonas SN, Valsami G, Liapis CD. The association of arterial stiffness with significant carotid atherosclerosis and carotid plaque vulnerability. Angiology. 2022;73(7):668-74. doi: https://doi.org/10.1177/00033197211068936
Cao Y, Zhang T. Clinical value of ultrasound in the evaluation of vascular function after carotid plaque formation. Frontiers in Medical Science Research. 2023;5(7):23-8. doi: https://doi.org/10.25236/FMSR.2023.050704
Visseren FL, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). Rev Esp Cardiol (Engl Ed). 2022;75(5):429. English, Spanish. doi: https://doi.org/10.1016/j.rec.2022.04.003
Wang Z, Zhang M, Zhang Y, Shen H, Dai X, Chen L, et al. The study of carotid atherosclerosis plaque biomechanics patients with metabolic syndrome using multiple tracking techniques. Heart. 2012;98(Suppl 2):E26.1-E26. doi: https://doi.org/10.1136/heartjnl-2012-302920a.57
Chen J, Li W, Cao J, Lu Y, Wang C, Lu J. Risk factors for carotid plaque formation in type 2 diabetes mellitus. J Transl Med. 2024;22(1):18. doi: https://doi.org/10.1186/s12967-023-04836-7
Porcu M, Mannelli L, Melis M, Suri JS, Gerosa C, Cerrone G, et al. Carotid plaque imaging profiling in subjects with risk factors (diabetes and hypertension). Cardiovasc Diagn Ther. 2020;10(4):1005-18. doi: https://doi.org/10.21037/cdt.2020.01.13
Saba L, Yuan C, Hatsukami TS, Balu N, Qiao Y, DeMarco JK, et al. Carotid Artery Wall Imaging: Perspective and Guidelines from the ASNR Vessel Wall Imaging Study Group and Expert Consensus Recommendations of the American Society of Neuroradiology. AJNR Am J Neuroradiol. 2018;39(2):E9-E31. doi: https://doi.org/10.3174/ajnr.A5488
Porcu M, Mannelli L, Melis M, Suri JS, Gerosa C, Cerrone G, et al. Carotid plaque imaging profiling in subjects with risk factors (diabetes and hypertension). Cardiovasc Diagn Ther. 2020;10(4):1005-18. doi: https://doi.org/10.21037/cdt.2020.01.13
O'Rourke M. Mechanical principles in arterial disease. Hypertension. 1995;26(1):2-9. doi: https://doi.org/10.1161/01.hyp.26.1.2
Morioka T, Mori K, Emoto M. Is Stiffness Parameter β Useful for the Evaluation of Atherosclerosis?~ Its Clinical Implications, Limitations, and Future Perspectives ~. J Atheroscler Thromb. 2021;28(5):435-53. doi: https://doi.org/10.5551/jat.RV17047
Charvat J, Chlumsky J, Zakovicova E, Kvapil M. Common carotid artery intima-media thickness is not increased but distensibility is reduced in normotensive patients with type 2 diabetes compared with control subjects. J Int Med Res. 2010;38(3):860-9. doi: https://doi.org/10.1177/147323001003800312
Riley WA, Evans GW, Sharrett AR, Burke GL, Barnes RW. Variation of common carotid artery elasticity with intimal-medial thickness: the ARIC Study. Atherosclerosis Risk in Communities. Ultrasound Med Biol. 1997;23(2):157-64. doi: https://doi.org/10.1016/s0301-5629(96)00211-6
Arroyo LH, Lee RT. Mechanisms of plaque rupture: mechanical and biologic interactions. Cardiovasc Res. 1999;41(2):369-75. doi: https://doi.org/v10.1016/s0008-6363(98)00308-3
Sell DR, Monnier VM. Molecular basis of arterial stiffening: role of glycation - a mini-review. Gerontology. 2012;58(3):227-37. doi: https://doi.org/10.1159/000334668
Wang Y, Zeinali-Davarani S, Davis EC, Zhang Y. Effect of glucose on the biomechanical function of arterial elastin. J Mech Behav Biomed Mater. 2015;49:244-54. doi: https://doi.org/10.1016/j.jmbbm.2015.04.025
Prenner SB, Chirinos JA. Arterial stiffness in diabetes mellitus. Atherosclerosis. 2015;238(2):370-9. doi: https://doi.org/10.1016/j.atherosclerosis.2014.12.023
Cui C, Zhang T, Qi Y, Chu J, Xu H, Sun C, et al. Diabetes, glycemic control and arterial stiffness: a real-world cohort study in the context of predictive, preventive, and personalized medicine. EPMA J. 2023;14(4):663-72. doi: https://doi.org/10.1007/s13167-023-00347-z
Yang X, Chen J, Pan A, Wu JH, Zhao F, Xie Y, et al. Association between Higher Blood Pressure and Risk of Diabetes Mellitus in Middle-Aged and Elderly Chinese Adults. Diabetes Metab J. 2020;44(3):436-45. doi: https://doi.org/10.4093/dmj.2019.0081
Tian X, Zuo Y, Chen S, Zhang Y, Zhang X, Xu Q, et al. Hypertension, Arterial Stiffness, and Diabetes: a Prospective Cohort Study. Hypertension. 2022;79(7):1487-96. doi: https://doi.org/10.1161/HYPERTENSIONAHA.122.19256
Downloads
Published
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
