The Association between Carotid Atherosclerosis and Glucose

Article information

Diabetes Metab J. 2011;35(5):466-468
Publication date (electronic) : 2011 October 31
doi :
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
2Department of Internal Medicine, Boramae Medical Center, Seoul, Korea.
Corresponding author: Bo Kyung Koo. Department of Internal Medicine, Boramae Medical Center, 39 Boramae Road, Dongjak-gu, Seoul 156-707, Korea.

Carotid intimal-medial thickness (IMT) is used as a surrogate marker for atherosclerosis and can predict future clinical cardiovascular events such as myocardial infarction and ischemic stroke [1]. Furthermore, medications for prevention of cardiovascular events including lipid-lowering [2], anti-hypertensive [3], and anti-platelet drugs [4,5] can decrease carotid IMT, which implicates that carotid IMT can also be used to assess the efficacy of anti-atherosclerotic treatment.

It is well documented that carotid IMT is markedly increased in subjects with high-cardiovascular disease risk such as those with diabetes [6], previous history of stroke [7] or myocardial infarction [8]. However, recent studies showed that subjects in the relatively low-risk group such as young subjects with obesity [9,10] or impaired glucose tolerance [11] also had increased carotid IMT compared to that of normal controls. In those low-risk subjects, glucose level significantly correlated with carotid IMT [10,12]. Non-diabetic subjects with parental history of diabetes or dyslipidemia also showed that disturbed carbohydrate metabolism is associated with carotid atherosclerosis [13,14]. In contrast, control of postprandial hyperglycemia by medication can regress carotid atherosclerosis [15].

Insulin resistance and inflammation might play an important role in the link between glucose abnormalities and carotid atherosclerosis [16,17]. Agewall et al. [18] showed a significant correlation between insulin sensitivity directly-assessed by clamp-study and carotid IMT in non-diabetic subjects. Inflammatory markers such as C-reactive protein [19,20] and TNF-α [21] are also significantly correlated with carotid IMT. History of gestational diabetes (GDM) is a risk factor of diabetes mellitus and is also characterized by insulin resistance [22,23]. Ku et al. [24] were unable to show a significant difference in carotid IMT according to history of GDM; however, they did show that glucose level in the postpartum period is significantly associated with carotid IMT in subjects with a previous history of GDM. This result shows agreement with previous studies focusing on other risk groups such as subjects with parental history of diabetes, obesity or dyslipidemia [13,14].

Considering the association between glucose abnormality and carotid atherosclerosis, screening and management of glucose abnormality in subjects with history of GDM is required. In addition, the significantly high risk of cardiovascular disease in subjects with history of GDM [22,23] calls for the concomitant management of other cardiovascular risk factors in such patients. However, considering cost, selection of a high risk group for future cardiovascular events might be required, and carotid IMT can provide such evidence. A prospective study to confirm the longitudinal association between glucose control and carotid IMT in subjects with a history of GDM and usefulness of carotid IMT is required.


No potential conflict of interest relevant to this article was reported.


1. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007;115:459–467. 17242284.
2. Paraskevas KI, Hamilton G, Mikhailidis DP. Statins: an essential component in the management of carotid artery disease. J Vasc Surg 2007;46:373–386. 17664116.
3. Wang JG, Staessen JA, Li Y, Van Bortel LM, Nawrot T, Fagard R, Messerli FH, Safar M. Carotid intima-media thickness and antihypertensive treatment: a meta-analysis of randomized controlled trials. Stroke 2006;37:1933–1940. 16763185.
4. Katakami N, Kim YS, Kawamori R, Yamasaki Y. The phosphodiesterase inhibitor cilostazol induces regression of carotid atherosclerosis in subjects with type 2 diabetes mellitus: principal results of the Diabetic Atherosclerosis Prevention by Cilostazol (DAPC) study--a randomized trial. Circulation 2010;121:2584–2591. 20516379.
5. Ahn CW, Lee HC, Park SW, Song YD, Huh KB, Oh SJ, Kim YS, Choi YK, Kim JM, Lee TH. Decrease in carotid intima media thickness after 1 year of cilostazol treatment in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2001;52:45–53. 11182215.
6. Temelkova-Kurktschiev TS, Koehler C, Leonhardt W, Schaper F, Henkel E, Siegert G, Hanefeld M. Increased intimal-medial thickness in newly detected type 2 diabetes: risk factors. Diabetes Care 1999;22:333–338. 10333954.
7. O'Leary DH, Polak JF, Kronmal RA, Kittner SJ, Bond MG, Wolfson SK Jr, Bommer W, Price TR, Gardin JM, Savage PJ. The CHS Collaborative Research Group. Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. Stroke 1992;23:1752–1760. 1448826.
8. Salonen JT, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 1991;11:1245–1249. 1911709.
9. Hacihamdioglu B, Okutan V, Yozgat Y, Yildirim D, Kocaoglu M, Lenk MK, Ozcan O. Abdominal obesity is an independent risk factor for increased carotid intima-media thickness in obese children. Turk J Pediatr 2011;53:48–54. 21534339.
10. Litwin M, Niemirska A. Intima-media thickness measurements in children with cardiovascular risk factors. Pediatr Nephrol 2009;24:707–719. 18784945.
11. Brohall G, Oden A, Fagerberg B. Carotid artery intima-media thickness in patients with type 2 diabetes mellitus and impaired glucose tolerance: a systematic review. Diabet Med 2006;23:609–616. 16759301.
12. Bhuiyan AR, Srinivasan SR, Chen W, Paul TK, Berenson GS. Correlates of vascular structure and function measures in asymptomatic young adults: the Bogalusa Heart Study. Atherosclerosis 2006;189:1–7. 16569409.
13. Temelkova-Kurktschiev T, Koehler C, Schaper F, Henkel E, Hahnefeld A, Fuecker K, Siegert G, Hanefeld M. Relationship between fasting plasma glucose, atherosclerosis risk factors and carotid intima media thickness in non-diabetic individuals. Diabetologia 1998;41:706–712. 9662054.
14. Thalhammer C, Balzuweit B, Busjahn A, Walter C, Luft FC, Haller H. Endothelial cell dysfunction and arterial wall hypertrophy are associated with disturbed carbohydrate metabolism in patients at risk for cardiovascular disease. Arterioscler Thromb Vasc Biol 1999;19:1173–1179. 10323767.
15. Hanefeld M. Treatment of impaired glucose tolerance with acarbose and its effect on intima-media thickness: a substudy of the STOP-NIDDM trial (study to prevent non-insulin-dependent diabetes mellitus). Endocr Pract 2006;12(Suppl 1):56–59. 16627382.
16. Giannini C, de Giorgis T, Scarinci A, Ciampani M, Marcovecchio ML, Chiarelli F, Mohn A. Obese related effects of inflammatory markers and insulin resistance on increased carotid intima media thickness in pre-pubertal children. Atherosclerosis 2008;197:448–456. 17681348.
17. Banerjee D, Recio-Mayoral A, Chitalia N, Kaski JC. Insulin resistance, inflammation, and vascular disease in nondiabetic predialysis chronic kidney disease patients. Clin Cardiol 2011;34:360–365. 21538390.
18. Agewall S, Fagerberg B, Attvall S, Wendelhag I, Urbanavicius V, Wikstrand J. Carotid artery wall intima-media thickness is associated with insulin-mediated glucose disposal in men at high and low coronary risk. Stroke 1995;26:956–960. 7762045.
19. Mita T, Watada H, Uchino H, Shimizu T, Hirose T, Tanaka Y, Kawamori R. Association of C-reactive protein with early-stage carotid atherosclerosis in Japanese patients with early-state type 2 diabetes mellitus. Endocr J 2006;53:693–698. 16926521.
20. Hee Choi S, Chang Kim H, Woo Ahn C, Keun Cho H, Soo Cha B, Chung YS, Woo Lee K, Chul Lee H, Bum Huh K, Kim DJ. Is high-sensitivity C-reactive protein associated with carotid atherosclerosis in healthy Koreans? Eur J Cardiovasc Prev Rehabil 2005;12:548–554. 16319544.
21. Freitas WM, Quaglia LA, Santos SN, Soares AA, Japiassu AV, Boaventura V, dos Santos Barros E, Cordova C, Nobrega OT, Sposito AC. Association of systemic inflammatory activity with coronary and carotid atherosclerosis in the very elderly. Atherosclerosis 2011;216:212–216. 21316055.
22. Metzger BE. Long-term outcomes in mothers diagnosed with gestational diabetes mellitus and their offspring. Clin Obstet Gynecol 2007;50:972–979. 17982340.
23. Davis CL, Gutt M, Llabre MM, Marks JB, O'Sullivan MJ, Potter JE, Landel JL, Kumar M, Schneiderman N, Gellman M, Skyler JS. History of gestational diabetes, insulin resistance and coronary risk. J Diabetes Complications 1999;13:216–223. 10616862.
24. Ku YH, Choi SH, Lim S, Cho YM, Park YJ, Park KS, Kim SY, Jang HC. Carotid intimal-medial thickness is not increased in women with previous gestational diabetes mellitus. Diabetes Metab J 2011;35:497–503.

Article information Continued