Endocrinology and Metabolism

Review Article

Diabetes
Recent Updates on Vascular Complications in Patients with Type 2 Diabetes Mellitus: Chan-Hee Jung, Ji-Oh Mok; Endocrinol Metab. 2020;35(2):260-271. Published online June 24, 2020; DOI: https://doi.org/10.3803/EnM.2020.35.2.260

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It is well known that patients with type 2 diabetes mellitus (T2DM) are at an increased risk of morbidity and mortality from atherosclerotic cardiovascular (CV) complications. Previously, the concept that diabetes mellitus (DM) is a “coronary artery disease (CAD) risk equivalent” was widely accepted, implying that all DM patients should receive intensive management. However, considerable evidence exist for wide heterogeneity in the risk of CV events among T2DM patients and the concept of a “CAD risk equivalent” has changed. Recent guidelines recommend further CV risk stratification in T2DM patients, with treatment tailored to the risk level. Although imaging modalities for atherosclerotic cardiovascular disease (ASCVD) have been used to improve risk prediction, there is currently no evidence that imaging-oriented therapy improves clinical outcomes. Therefore, controversy remains whether we should screen for CVD in asymptomatic T2DM. The coexistence of T2DM and heart failure (HF) is common. Based on recent CV outcome trials, sodium glucose cotransporter-2 inhibitors and glucagon like peptide-1 receptor agonists are recommended who have established ASCVD, indicators of high risk, or HF because of their demonstrated benefits for CVD. These circumstances have led to an increasing emphasis on ASCVD and HF in T2DM patients. In this review, we examine the literature published within the last 5 years on the risk assessment of CVD in asymptomatic T2DM patients. In particular, we review recent guidelines regarding screening for CVD and research focusing on the role of coronary artery calcium, coronary computed tomography angiography, and carotid intima-media thickness in asymptomatic T2DM patients.

Citations

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International Journal of Molecular Sciences.2023; 24(5): 4319. CrossRef
Increased soluble endoglin levels in newly-diagnosed type 2 diabetic patients are associated with endothelial dysfunction
Xiaobing Dou, Xiujing Wang, Xiuhua Yu, Jiaqi Yao, Huiling Shen, Yao Xu, Bojing Zheng, Zhenying Zhang, Qingying Tan, Tianxiao Hu
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Effects of hypertension on subcortical nucleus morphological alternations in patients with type 2 diabetes
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Original Articles

Clinical Study
Subclinical Atherosclerosis in Patients with Cushing Syndrome: Evaluation with Carotid Intima-Media Thickness and Ankle-Brachial Index: Luigi Petramala, D'Elia Lorenzo, Gino Iannucci, Antonio Concistré, Laura Zinnamosca, Cristiano Marinelli, Giuseppe De Vincentis, Antonio Ciardi, Giorgio De Toma, Claudio Letizia; Endocrinol Metab. 2015;30(4):488-493. Published online December 31, 2015; DOI: https://doi.org/10.3803/EnM.2015.30.4.488

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Abstract PDF PubReader

Background

Cushing syndrome (CS) has been described as a killing disease due its cardiovascular complications. In fact, chronic cortisol excess leads to a constellation of complications, including hypertension, hyperglycemia, adiposity, and thromboembolism. The main vascular alteration associated with CS is atherosclerosis.

Methods

Aim of this study was to analyze carotid intima-media thickness (cIMT) and ankle-brachial index (ABI), two surrogate markers of subclinical atherosclerosis in a consecutive series of CS patients, compared to patients with essential hypertension (EH) and health subjects (HS).

Results

Patients with CS showed a significant increase (P<0.05) of cIMT (0.89±0.17 mm) compared to EH (0.81±0.16 mm) and HS (0.75±0.4 mm), with a high prevalence of plaque (23%; P<0.03). Moreover, CS patients showed a mean ABI values (1.07±0.02) significantly lower respect to HS (1.12±0.11; P<0.05), and a higher percentage (20%) of pathological values of ABI (≤0.9; P<0.03).

Conclusion

In conclusion, we confirmed and extended the data of cIMT in CS, and showed that the ABI represent another surrogate marker of subclinical atherosclerosis in this disease.

Citations

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Clare MacLeod, Patrick W. F. Hadoke, Mark Nixon
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Cardiovascular and metabolic risk factors in patients with subclinical Cushing
Luigi Petramala, Federica Olmati, Antonio Concistrè, Riccardo Russo, Martina Mezzadri, Maurizio Soldini, Giuseppe De Vincentis, Gino Iannucci, Giorgio De Toma, Claudio Letizia
Endocrine.2020; 70(1): 150. CrossRef
Should Cushing's Syndrome be Considered as a Disease with High Cardiovascular Risk in Relevant Guidelines?
Goran Koracevic, Milan Stojkovic, Dragan Lovic, Milan Pavlovic, Tomislav Kostic, Marija Kutlesic, Sladjana Micic, Maja Koracevic, Milan Djordjevic
Current Vascular Pharmacology.2019; 18(1): 12. CrossRef
Markers of atherosclerosis in patients with Cushing’s syndrome: a meta-analysis of literature studies
Roberta Lupoli, Pasquale Ambrosino, Anna Tortora, Livia Barba, Gelsy Arianna Lupoli, Matteo Nicola Dario Di Minno
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Obesity and Metabolism
Association between Cardiac Autonomic Neuropathy, Diabetic Retinopathy and Carotid Atherosclerosis in Patients with Type 2 Diabetes: Chan-Hee Jung, Ae-Rin Baek, Kyu-Jin Kim, Bo-Yeon Kim, Chul-Hee Kim, Sung-Koo Kang, Ji-Oh Mok; Endocrinol Metab. 2013;28(4):309-319. Published online December 12, 2013; DOI: https://doi.org/10.3803/EnM.2013.28.4.309

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Abstract PDF PubReader

Background

It is not clear whether microangiopathies are associated with subclinical atherosclerosis in type 2 diabetes mellitus (T2DM). We investigated the relation of cardiac autonomic neuropathy (CAN) and other microangiopathies with carotid atherosclerosis in T2DM.

Methods

A total of 131 patients with T2DM were stratified by mean carotid intima-media thickness (CIMT) ≥ or <1.0 mm and the number of carotid plaques. CAN was assessed by the five standard cardiovascular reflex tests according to the Ewing's protocol. CAN was defined as the presence of at least two abnormal tests or an autonomic neuropathy points ≥2. Diabetic microangiopathies were assessed.

Results

Patients with CAN comprised 77% of the group with mean CIMT ≥1.0 mm, while they were 29% of the group with CIMT <1.0 mm (P=0.016). Patients with diabetic retinopathy (DR) comprised 68% of the group with CIMT ≥1.0 mm, while they were 28% of the group without CIMT thickening (P=0.003). Patients with CAN comprised 51% of the group with ≥2 carotid plaques, while they were 23% of the group with ≤1 carotid plaque (P=0.014). In multivariable adjusted logistic regression analysis, the patients who presented with CAN showed an odds ratio [OR] of 8.6 (95% confidence interval [CI], 1.6 to 44.8) for CIMT thickening and an OR of 2.9 (95% CI, 1.1 to 7.5) for carotid plaques. Furthermore, patients with DR were 3.8 times (95% CI, 1.4 to 10.2) more likely to have CIMT thickening.

Conclusion

These results suggest that CAN is associated with carotid atherosclerosis, represented as CIMT and plaques, independent of the traditional cardiovascular risk factors in T2DM. CAN or DR may be a determinant of subclinical atherosclerosis in T2DM.

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