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Open Access Highly Accessed Original investigation

Multiple risk factor intervention reduces carotid atherosclerosis in patients with type 2 diabetes

Norbert J Tripolt12, Sophie H Narath3, Michaela Eder12, Thomas R Pieber1, Thomas C Wascher4 and Harald Sourij12*

Author Affiliations

1 Department for Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria

2 Cardiovascular Diabetology Research Group, Medical University of Graz, Graz, Austria

3 Institute for Biomedicine and Health Sciences, Joanneum Research, Graz, Austria

4 1st Medical Department, Hanusch Hospital, Vienna, Austria

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Cardiovascular Diabetology 2014, 13:95  doi:10.1186/1475-2840-13-95

Published: 23 May 2014

Abstract

Background

Patients with rapid progression of carotid intima media thickness (CIMT) were shown to have a higher future risk for cardiovascular events.

The aim of this study was to investigate the impact of multiple risk factor intervention on CIMT progression and to establish whether new cardiovascular surrogate measurements would allow prediction of CIMT changes.

Materials and methods

In this prospective, open, 2-years study, we included 97 patients with type 2 diabetes and at least two insufficiently treated cardiovascular risk factors, i.e. HbA1c > 7.5% (58 mmol/mol); LDL-cholesterol >3.1 mmol/l or blood pressure >140/90 mmHg. Treatment was intensified according to current guidelines over 3 months with the aim to maintain intensification over 2 years.

The primary outcome was the change in CIMT after 2 years. We also assessed markers of mechanical and biochemical endothelial function and endothelial progenitor cells before and after 3 months of treatment intensification. For testing differences between before and after multifactorial treatment measurements we used either the paired student’s t-test or the Wilcoxon signed-rank test, depending on the distribution of the data. Additional, explorative statistical data analysis was done on CIMT progression building a linear multivariate regression model.

Results

Blood glucose, lipids and blood pressure significantly improved during the first 3 months of intensified treatment, which was sustained over the 2-year study duration. Mean CIMT significantly decreased from baseline to 2 year (0.883 ± 0.120 mm vs. 0.860 ± 0.130 mm; p = 0.021). None of the investigated surrogate measures, however, was able to predict changes in IMT early after treatment intensification.

Conclusions

Intensification of risk factor intervention in type 2 diabetes results in CIMT regression over a period of 2 years. None of the biomarkers used including endothelial function parameters or endothelial progenitor cells turned out to be useful to predict CIMT changes.

Trial registration

Clinical Trial Registration – Unique identifier: NCT00660790

Keywords:
Intensified risk factor intervention; Carotid intima media thickness; Type 2 diabetes; Cardiovascular surrogate measurements; Carotid atherosclerosis