Predictors of subclinical atherosclerosis evaluated by carotid intima-media thickness in asymptomatic young women with type 1 diabetes mellitus

Association of obesity- and insulin resistance-related indices with subclinical carotid atherosclerosis in type 1 diabetes: a cross-sectional study

BACKGROUND

Obesity and insulin resistance are well-established risk factors for atherosclerosis and cardiovascular disease (CVD). Although some obesity- and insulin resistance-related indices (OIRIs) have been linked to CVD, their associations with subclinical carotid atherosclerosis (SCA) in individuals with type 1 diabetes (T1D) remain unclear. This study aims to systematically explore and compare the associations of various common OIRIs with SCA in T1D population.

METHODS

A total of 418 adult inpatients with classic T1D admitted from October 2008 to June 2021 to the First Affiliated Hospital of Air Force Medical University in Xi'an, China were included in this study. Demographic, anthropometric, and laboratory data were collected. Studied OIRIs comprised body mass index, waist-to-height ratio, waist-to-hip ratio (WHR), a body shape index, abdominal volume index, body adiposity index, body roundness index, conicity index, triglyceride-glucose index, visceral adiposity index, Chinese visceral adiposity index (CVAI), lipid accumulation product, estimated glucose disposal rate (eGDR), triglyceride-to-HDL ratio, and cardiometabolic index. Binary logistic regression, restricted cubic spline (RCS), and receiver operating characteristic curves were used to examine the associations of these indices with SCA.

RESULTS

In multivariable logistic regression analyses, after adjusting for potential confounders, per 1.0-standard deviation (SD) increase in CVAI (OR, 95% CI: 1.68, 1.16-2.47), eGDRWHR (eGDR calculated with WHR; OR, 95% CI: 0.44, 0.22-0.82), and eGDRWC (eGDR calculated with waist circumference; OR, 95% CI: 0.49, 0.24-0.93) were significantly associated with SCA. CVAI exhibited the highest area under the curve (AUC) in diagnosing SCA, with a value of 0.73 (95% CI: 0.69-0.77). RCS analyses indicated a linear and positive association between CVAI and SCA in the overall population and the females. Subgroup analyses and sensitivity analyses further supported the association between CVAI and SCA. Additionally, adding CVAI to the Steno Type 1 Risk Engine (ST1RE) improved the reclassification, but did not enhance the overall discriminative ability of ST1RE to identify SCA.

CONCLUSION

Among various OIRIs, CVAI shows the strongest association with SCA in adults with T1D. These findings suggest that CVAI may merit further longitudinal investigation as a potential marker for SCA assessment in this population.

Choroidal thickness as predictor of subclinical carotid atherosclerosis in adults with type 1 diabetes

Patients with Type 1 Diabetes (T1DM) have a higher risk of cardiovascular disease. This study used carotid ultrasound to identify subclinical carotid plaques and Optical Coherence Tomography (OCT) to evaluate ophthalmological markers as predictors of carotid plaque presence in 242 adults with T1DM, employing machine learning models for early risk assessment. Individuals with carotid plaques (N = 67) did not show significant differences in retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) and inner plexiform layer (IPL) complex compared to those without (N = 175). However, subfoveal and temporal choroidal area thickness significantly decreased in individuals with plaques (P ≤ 0.01). Machine learning identified age, hypertension, dyslipidemia, smoking, and diabetic retinopathy as key predictors for plaque presence, while ophthalmological measures made a modest contribution. Choroidal thickness exhibited an inverse relationship with plaque risk. Despite robust accuracy and high specificity (82-85% and 92-98%, respectively), the models were overly conservative in predicting positive instances (balanced accuracy of 0.60 for the left eye and 0.71 for the right eye). If further validated, choroidal thickness could complement traditional risk factors as an early marker of CV risk in T1DM patients. Integrating this measure in specialized clinical settings could help identify individuals who may need additional cardiovascular assessments.

Predictive markers of early endothelial dysregulation in type-1 diabetes: a meta-analysis

BACKGROUND

This study identifies a new set of salient risk factors that may trigger danger signals of vascular dysregulation in T1D. Vascular abnormalities and impairment of CVD is a major adverse effect of T1D, particularly affecting children, adolescents and young adults.

METHODS

The patients of T1D were compared with the healthy control (HC) for the risk factors of vascular dysregulation in published studies from year 2013 to 2023. The PubMed, Web of Science and Google Scholar databases were searched from 1/1/2013 to 1/9/2023. The risk of bias was assessed with the Cochrane (ROBINS-I ) tool, relevant to clinical subjects. A random effects model was followed and analysed by RevMan 5.4 and GraphPad Prism software.

RESULTS

80 relevant case-control studies having 7492 T1D patients and 5293 HC were included. The age and sex-matched HC consisted of persons free of disease and not under any medication while clinical subjects of < 40 years were included. 28 risk factors were grouped into six primary outcome models, all of which favoured the T1D synonymous with a high risk of CVD.

CONCLUSION

Our findings have strong implications for improving the quality of life and health economics related to vascular disease in T1D. HbA1c% is the most effective biomarker, followed by FBG, LDL-c, AI%, sICAM-1, and FMD% which could be evaluated with a simple blood test or non-invasive techniques. These may serve dual purposes as biomarkers of rapid diagnosis that could offer prospective tailor-made therapeutics for T1D. (Protocol registered at https://www.crd.york.ac.uk/prospero/CRD42022384636 ).

Plasma Lipidomics Profiles Highlight the Associations of the Dual Antioxidant/Pro-oxidant Molecules Sphingomyelin and Phosphatidylcholine with Subclinical Atherosclerosis in Patients with Type 1 Diabetes

Here, we report on our study of plasma lipidomics profiles of patients with type 1 diabetes (T1DM) and explore potential associations. One hundred and seven patients with T1DM were consecutively recruited. Ultrasound imaging of peripheral arteries was performed using a high image resolution B-mode ultrasound system. Untargeted lipidomics analysis was performed using UHPLC coupled to qTOF/MS. The associations were evaluated using machine learning algorithms. SM(32:2) and ether lipid species (PC(O-30:1)/PC(P-30:0)) were significantly and positively associated with subclinical atherosclerosis (SA). This association was further confirmed in patients with overweight/obesity (specifically with SM(40:2)). A negative association between SA and lysophosphatidylcholine species was found among lean subjects. Phosphatidylcholines (PC(40:6) and PC(36:6)) and cholesterol esters (ChoE(20:5)) were associated positively with intima-media thickness both in subjects with and without overweight/obesity. In summary, the plasma antioxidant molecules SM and PC differed according to the presence of SA and/or overweight status in patients with T1DM. This is the first study showing the associations in T1DM, and the findings may be useful in the targeting of a personalized approach aimed at preventing cardiovascular disease in these patients.

Early Markers of Cardiovascular Disease Associated with Clinical Data and Autosomal Ancestry in Patients with Type 1 Diabetes: A Cross-Sectional Study in an Admixed Brazilian Population

Patients with type 1 diabetes (T1D) have a higher risk of developing cardiovascular disease (CVD), which is a major cause of death in this population. This study investigates early markers of CVD associated with clinical data and autosomal ancestry in T1D patients from an admixed Brazilian population. A cross-sectional study was conducted with 99 T1D patients. The mean age of the study sample was 27.6 years and the mean duration of T1D was 14.4 years. The frequencies of abnormalities of the early markers of CVD were 19.6% in the ankle-brachial index (ABI), 4.1% in the coronary artery calcium score (CACS), and 5% in the carotid Doppler. A significant percentage of agreement was observed for the comparison of the frequency of abnormalities between CACS and carotid Doppler (92.2%, p = 0.041). There was no significant association between the level of autosomal ancestry proportions and early markers of CVD. The ABI was useful in the early identification of CVD in asymptomatic young patients with T1D and with a short duration of disease. Although CACS and carotid Doppler are non-invasive tests, carotid Doppler is more cost-effective, and both have limitations in screening for CVD in young patients with a short duration of T1D. We did not find a statistically significant relationship between autosomal ancestry proportions and early CVD markers in an admixed Brazilian population.

Coronary Artery Disease Events and Carotid Intima-Media Thickness in Type 1 Diabetes in the DCCT/EDIC Cohort

Background

Carotid artery intima‐media thickness (IMT) is associated with the risk of subsequent cardiovascular events in the general population. This association has not been established in type 1 diabetes.

Methods and Results

We studied if carotid IMT is associated with the risk of a first coronary artery disease event in participants with type 1 diabetes in the EDIC (Epidemiology of Diabetes Interventions and Complications) study, the long‐term observational follow‐up of the DCCT (Diabetes Control and Complications Trial). Between 1994 and 1996, common carotid artery and internal carotid artery IMT were measured with high‐resolution ultrasound in 1309 study participants with a mean age of 35 years and diabetes duration of 13.8 years; 52% were men. Cox proportional hazards models evaluated the association of standardized common carotid artery IMT and internal carotid artery IMT with subsequent cardiovascular events over the next 17 years. Models were adjusted for age, sex, mean hemoglobin A1c levels, and traditional cardiovascular risk factors. Associations of common carotid artery IMT with subsequent CAD were significant after adjustment for imaging device, sex, and age (hazard ratio [HR], 1.23 per 0.09 mm [95% CI, [1.04–1.45]; P=0.0141), but did not remain significant after further adjustment for traditional risk factors and hemoglobin A1c (HR, 1.14 per 0.09 mm [95% CI, 0.97–1.33]; P=0.1206). No significant associations with subsequent coronary artery disease events were seen for internal carotid artery IMT.

Conclusions

In the DCCT/EDIC cohort with type 1 diabetes, common carotid artery IMT, but not internal carotid artery IMT, is weakly associated with subsequent coronary artery events, an association eliminated after adjusting for coexistent traditional cardiovascular risk factors.

Registration

URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00360815 and NCT00360893.

Detection of early ultrasonographic markers of cardiovascular dysfunction in prediabetes patients: Cardiovascular markers in prediabetes

BACKGROUND

Prediabetes individuals may present incipient signals of cardiovascular injury and evaluate with unfavorable outcome. The aim of this study was to identify early ultrasonographic markers of cardiac dysfunction and arterial stiffness among glucose intolerant patients compared to healthy individuals.

METHODS

Cross-sectional study with the composition of two groups: Prediabetes (PD) who met the criteria for pre-diabetes and Normoglycemic (NG): presented no criteria of pre-diabetes and diabetes mellitus in all applied tests. Clinical evaluation, assessment of cardiac function by transthoracic echocardiogram, carotid intima-media thickness by carotid ultrasonographic and evaluation of arterial stiffness by SphygmoCor®ฏ device were performed.

RESULTS

Eighty adults were included in this study: PD (n=43) and NG (n=37). PD patients were more dyslipidemic and presented early alterations in echocardiographic variables, like: peak mitral velocity E (E (cm/s): NG 84±13 vs PD 77±11, p = 0.03), E/A Tricuspid inflow (NG: 1.5±0.4 vs PD 1.3±0.3, p=0.03), Tricuspid tissue Doppler E' (E'tric (cm/s): NG 15.2±4.4 vs PD 13.4±3.2, p=0.04) and increased arterial stiffness (Pulse Wave Velocity: PWV (m/s): NG 7.2±1.5 vs PD 7.9±1.7, p = 0.03). In the regression analysis, having an impaired oral glucose test was shown to be independently associated with reduced E Mitral, even after adjusting for a set of confounding factors.

CONCLUSION

PD patients showed early signals of an impaired cardiac function and an increased pulse wave velocity when compared with healthy individuals. These results point to treatment optimization strategies, especially when considering preventive measures for cardiovascular outcomes, like diabetic cardiomyopathy.

Association between the triglyceride-glucose index and carotid plaque stability in nondiabetic adults

BACKGROUND AND AIMS

The rupture of an unstable atherosclerotic plaque is one of the major causes of thrombosis. However, there was limited evidence on the relationship of triglyceride-glucose (TyG) index, a simple surrogate marker of insulin resistance, with the carotid plaque stability. This study aimed to investigate the association between the TyG index and carotid plaque stability in nondiabetic adults.

METHODS AND RESULTS

The study included 4748 nondiabetic participants from the Asymptomatic Polyvascular Abnormalities Community study. Carotid plaque stability was assessed using ultrasonography. The TyG index was calculated as ln [fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2]. Logistic regression was used to evaluate the association of the TyG index with carotid plaque stability by calculating odds ratio (OR) and 95% confidence interval (CI). Of the 4748 participants, 1192 (25.11%) participants had stable carotid plaque, and 1247 (26.26%) had unstable carotid plaque. The prevalence of unstable carotid plaque substantially increased with increasing TyG index tertile (P for trend <0.0001). In the fully adjusted model, the OR comparing participants in the highest versus the lowest tertile of the TyG index was 1.31 (95% CI, 1.09-1.57). The optimal cutoff point for the TyG index in case of unstable carotid plaque was 8.56. However, we did not observe a statistically significant association between the TyG index and stable carotid plaque.

CONCLUSIONS

Elevated the TyG index was significantly associated with the prevalence of unstable carotid plaque in nondiabetic adults.

MiR-221-3p as a Potential Biomarker for Patients with Psoriasis and Its Role in Inflammatory Responses in Keratinocytes

INTRODUCTION

This study investigated serum miR-221-3p levels in psoriatic patients and the characterization of serum miR-221-3p in keratinocyte inflammatory responses was further assessed.

METHODS

qRT-PCR was used to detect the expression level of miR-221-3p in the serum of 46 patients with psoriasis and 42 healthy controls. The receiver operating characteristic curve evaluated the diagnostic ability of miR-221-3p in psoriasis. The effect of miR-221-3p on HaCaT cell proliferation was detected by using a cell counting Kit-8 and Transwell. ELISA was used to detect serum and keratinocyte pro-inflammatory factors.

RESULTS

miR-221-3p was significantly increased in the serum of patients with psoriasis. The area under the curve was 0.861, the sensitivity was 80.4%, and the specificity was 85.7%. Serum miR-221-3p was positively correlated with the expression levels of tumor necrosis factor-α, interleukin (IL)-17A, and IL-22. Cell experiments showed that reducing the expression of miR-221-3p could significantly inhibit cell proliferation. Additionally, miR-221-3p downregulation also inhibited the release of some inflammatory factors in the HaCaT cells.

DISCUSSION/CONCLUSION

MiR-221-3p is a latent biomarker of psoriasis patients. Lower expression of miR-221-3p inhibits the cell proliferation and inflammatory responses of HaCaT cells, which offers a possible target for the therapeutic interventions of psoriasis.

MiR-455-5p serves as a biomarker of atherosclerosis and inhibits vascular smooth muscle cell proliferation and migration

Background: This study discussed the clinical value and expression level of miR-455-5p in atherosclerosis (AS) patients. Meanwhile, its regulatory effect on the proliferation and migration of vascular smooth muscle cells (VSMCs) was further analyzed. Materials & methods: Clinical experiments were detected by quantitative real-time PCR and receiver operating characteristic. Cell experiments were detected by CCK-8, transwell and luciferase reporter gene assay. Results: miR-455-5p was low expressed in AS patients and had diagnostic value to distinguish AS patients from healthy controls. MiR-455-5p inhibited the proliferation and migration of VSMCs. SOCS3 was the target gene of miR-455-5p. Conclusion: MiR-455-5p may be used as a potential diagnostic biomarker for AS. MiR-455-5p may inhibit the proliferation and migration of VSMCs through targeting SOCS3.

Insulin resistance is associated with preclinical carotid atherosclerosis in patients with type 1 diabetes

AIM

Although insulin resistance (IR) is a growing trait among type 1 diabetes (T1D) population, its relationship with atherosclerosis has been scarcely studied. We assessed the association between IR indexes and carotid atherosclerosis in T1D, a population at high cardiovascular disease (CVD) risk.

MATERIALS AND METHODS

We evaluated 191 participants with T1D and no prior CVD with at least one of the following criteria: ≥40 years old; diabetic nephropathy; or T1D duration ≥10 years harbouring ≥1 additional CVD risk factor. IR was assessed with the metabolic syndrome (MetS) harmonized definition proposed in 2009 and the estimated glucose disposal rate (eGDR), a T1D-specific IR surrogate marker (lower values indicating higher IR). Standardized carotid ultrasonography was performed, recording intima-media thickness (IMT), plaque presence and maximum height of plaque. Comparisons between patients according to their MetS status as well as concerning eGDR values were performed.

RESULTS

The participants' median age was 47.4 (41.1-53.3) years and diabetes duration 25.7 (21.6-32.5) years. Plaque prevalence was higher in patients with greater IR (49.1%, 29.1% and 20%, P = .001, for any plaque according to decreasing eGDR tertiles). Conversely, no statistically significant higher plaque prevalence was found in participants with MetS. In multivariate analyses (adjusted for general- and T1D-specific risk factors, and statin treatment), MetS was associated with neither IMT nor plaque. On the contrary, eGDR was independently related to ≥2 plaques (P = .018) and maximum plaque height (P < .01).

CONCLUSIONS

In T1D, IR assessed through eGDR but not by MetS definition was independently associated with plaque burden, a predictor of CVD.

Long-term trajectories of BMI predict carotid stiffness and plaque volume in type 2 diabetes older adults: a cohort study

BACKGROUND

High body mass index (BMI) is a risk factor for type 2 diabetes and cardiovascular disease. However, its relationships with indices of carotid stiffness and plaque volume are unclear. We investigated associations of long-term measurements of BMI with indices of carotid stiffness and atherosclerosis among non-demented diabetes patients from the Israel Diabetes and Cognitive Decline (IDCD) study.

METHODS

Carotid ultrasound indices [carotid intima media thickness (cIMT), distensibility, elastography and plaque volume] were assessed in N = 471 participants. Mean BMI across all MHS diabetes registry measurements and trajectories of BMI were calculated. BMI was categorized into three trajectory groups representing: a relatively stable normal weight (n = 185, 44%), overweight trajectory (n = 188, 44.8%) and a trajectory of obesity (n = 47, 11.2%). Linear and logistic regressions estimated associations of carotid indices with mean BMI and BMI trajectories.

RESULTS

Compared to the normal weight trajectory, an obesity trajectory was associated with carotid distensibility (β = - 3.078, p = 0.037), cIMT (β = 0.095, p = 0.004), and carotid elastography (β = 0.181, p = 0.004) but not with plaque volume (β = 0.066, p = 0.858). Compared with the normal weight trajectory, an obesity trajectory was associated with increased odds for impaired carotid distensibility (OR = 2.790, p = 0.033), impaired cIMT (OR = 5.277, p = 0.001) and large carotid plaque volume (OR = 8.456, p = 0.013) but not with carotid elastography (OR = 1.956, p = 0.140). Mean BMI was linearly associated with Distensibility (β = - 0.275, p = 0.005) and cIMT (β = 0.005, p = 0.026).

CONCLUSIONS

Long-term measurements of adiposity are associated with indices of carotid stiffness and plaque volume among older type 2 diabetes adults.

MicroRNA-186-5p serves as a diagnostic biomarker in atherosclerosis and regulates vascular smooth muscle cell proliferation and migration

Objective

MicroRNA dysregulation occurs in many human diseases, including atherosclerosis. Here, we examined the serum expression and clinical significance of miR-186-5p in patients with atherosclerosis, and explored its influence on vascular smooth muscle cell (VSMC) proliferation and migration.

Methods

Blood samples were collected from 104 patients with asymptomatic atherosclerosis and 80 healthy controls. Quantitative real-time PCR was applied to measure the miR-186-5p level. An ROC curve was established to assess the discriminatory ability of the serum miR-186-5p level for identifying atherosclerosis from controls. CCK-8 and Transwell assays were used to evaluate the impact of miR-186-5p on cell behaviors.

Results

Serum expression of miR-186-5p was significantly higher in atherosclerosis patients than in the control group. The serum miR-186-5p level showed a positive correlation with CIMT and could be used to distinguish atherosclerosis patients from healthy controls, with an area under the curve (AUC) score of 0.891. In VSMCs, overexpression of miR-186-5p significantly promoted cell proliferation and migration, while the opposite results were observed when miR-186-5p was downregulated.

Conclusion

Overexpression of miR-186-5p has a certain diagnostic significance for atherosclerosis. Upregulation of miR-186-5p stimulates VSMC proliferation and migration. Therefore, it is a possible target for atherosclerosis interventions.

Subclinical vascular disease in patients with diabetes is associated with insulin resistance

Patients with diabetes experience increased cardiovascular risk that is not fully explained by deficient glycemic control or traditional cardiovascular risk factors such as smoking and hypercholesterolemia. Asymptomatic patients with diabetes show structural and functional vascular damage that includes impaired vasodilation, arterial stiffness, increased intima-media thickness and calcification of the arterial wall. Subclinical vascular injury associated with diabetes predicts subsequent manifestations of cardiovascular disease, such as ischemic heart disease, peripheral artery disease and stroke. Noninvasive detection of subclinical vascular disease is commonly used to estimate cardiovascular risk associated to diabetes. Longitudinal studies in normotensive subjects show that arterial stiffness at baseline is associated with a greater risk for future hypertension independently of established risk factors. In patients with type 2 diabetes, vascular disease begins to develop during the latent phase of insulin resistance, long before the clinical diagnosis of diabetes. In contrast, patients with type 1 diabetes do not manifest vascular injury when they are first diagnosed due to insulin deficiency, as they lack the preceding period of insulin resistance. These findings suggest that insulin resistance plays an important role in the development of early vascular disease associated with diabetes. Cross-sectional and prospective studies confirm that insulin resistance is associated with subclinical vascular injury in patients with diabetes, independently of standard cardiovascular risk factors. Asymptomatic vascular disease associated with diabetes begins to occur early in life having been documented in children and adolescents. Insulin resistance should be considered a therapeutic target in order to prevent the vascular complications associated with diabetes.