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Study on risk factors of carotid atherosclerosis in type 2 diabetes mellitus and development of prediction model

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International Journal of Diabetes in Develo** Countries Aims and scope Submit manuscript

Abstract

Background

Diabetes mellitus is a metabolic disease, characterized by chronic hyperglycemia that increases the risk of cardiovascular and cerebrovascular diseases.

Objective 

The aim of this study was to investigate the risk factors of carotid atherosclerosis in patients with type 2 diabetes mellitus (T2DM), and establish an accurate and simple prediction model for its development.

Methods

The data of 435 patients with T2DM were collected from September 2021 to March 2022 at the First People’s Hospital of Lin** District. The least absolute shrinkage and selection operator regression and stepwise backward regression were used to screen variables, and multivariate logistic regression analysis was performed to establish a nomogram prediction model.

Results

The results showed that the risk factors of T2DM with carotid atherosclerosis included male sex, elderly age, long course of disease, hypertension, cerebral infarction, alcohol drinking, and high level of low-density lipoprotein cholesterol. The models showed good discrimination with an area under the receiver operating characteristic curve of 0.862 (95%CI: 0.827–0.898) and 0.871 (95%CI: 0.837–0.905) and a good calibration. The cutoff value of the net reclassification improvement was − 0.0134 (95%CI: − 0.0897 to 0.0496, p = 0.703), and the integrated discrimination improvement was − 0.0163 (95%CI: − 0.0291 to − 0.0036, p = 0.012), indicating that there is no significant difference in the accuracy of the two prediction models, but the prediction probability of model A is slightly worse than that of model B.

Conclusion

Two prediction models were developed to assist with the early screening of carotid atherosclerosis in T2DM patients.

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Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

References

  1. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119.

    Article  PubMed  Google Scholar 

  2. American Diabetes Association. 10. Cardiovascular disease and risk management: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S111–34.

    Article  Google Scholar 

  3. Braunwald E. Diabetes, heart failure, and renal dysfunction: the vicious circles. Prog Cardiovasc Dis. 2019;62(4):298–302.

    Article  PubMed  Google Scholar 

  4. Lee SH, Hwang SM, Kang DH, Yang HJ. Brain education-based meditation for patients with hypertension and/or type 2 diabetes: a pilot randomized controlled trial. Medicine (Baltimore). 2019;98(19):e15574.

    Article  PubMed  Google Scholar 

  5. Henning RJ. Type-2 diabetes mellitus and cardiovascular disease. Future Cardiol. 2018;14(6):491–509.

    Article  CAS  PubMed  Google Scholar 

  6. Wu Y, He J, Sun X, Zhao YM, Lou HY, Ji XL, et al. Carotid atherosclerosis and its relationship to coronary heart disease and stroke risk in patients with type 2 diabetes mellitus. Medicine (Baltimore). 2017;96(39):e8151.

    Article  PubMed  Google Scholar 

  7. American Diabetes Association. 2 Classification and diagnosis of diabetes: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14–31.

    Article  Google Scholar 

  8. Zhong P, Lu Z, Li T, Lan Q, Liu J, Wang Z, et al. Association between regular blood pressure monitoring and the risk of intracranial aneurysm rupture: a Multicenter Retrospective Study with Propensity Score Matching. Transl Stroke Res. 2022;13(6):983–94.

    Article  CAS  PubMed  Google Scholar 

  9. Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391(10129):1513–23.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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. Eur Heart J. 2018;39(33):3021–104.

    Article  PubMed  Google Scholar 

  11. Utazirubanda JC, Leon T, Ngom P. Variable selection with Group LASSO approach: application to Cox regression with frailty model. Commun Stat Simul Comput. 2021;50(3):881–901.

    Article  PubMed  Google Scholar 

  12. Zhang Z. Variable selection with stepwise and best subset approaches. Ann Transl Med. 2016;4(7):136.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Balachandran VP, Gonen M, Smith JJ, DeMatteo RP. Nomograms in oncology: more than meets the eye. Lancet Oncol. 2015;16(4):e173–80.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wei L, Champman S, Li X, Li X, Li S, Chen R, et al. Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: a cross-sectional study in China. BMJ Open. 2017;7(10):e017293.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sanchez-Pinto LN, Venable LR, Fahrenbach J, Churpek MM. Comparison of variable selection methods for clinical predictive modeling. Int J Med Inform. 2018;116:10–7.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Guo F, Zhou T, Tang J, Dong M, Wei Q. Related risk factors between subclinical carotid atherosclerosis and diabetic retinopathy in newly diagnosed type 2 diabetes mellitus in China. Exp Clin Endocrinol Diabetes. 2021;129(4):283–8.

    Article  CAS  PubMed  Google Scholar 

  17. Kulkarni NB, Ganu MU, Godbole SG, Deo SS. Effect of age and blood pressure on surrogate markers of atherosclerosis in patients with type 2 diabetes mellitus. J Clin Diagn Res. 2014;8(6):BC08-11.

    PubMed  PubMed Central  Google Scholar 

  18. Veerasamy M, Ford GA, Neely D, Bagnall A, MacGowan G, Das R, et al. Association of aging, arterial stiffness, and cardiovascular disease: a review. Cardiol Rev. 2014;22(5):223–32.

    Article  PubMed  Google Scholar 

  19. Sugiura T, Dohi Y, Takagi Y, Yoshikane N, Ito M, Suzuki K, et al. Impacts of lifestyle behavior and shift work on visceral fat accumulation and the presence of atherosclerosis in middle-aged male workers. Hypertens Res. 2020;43(3):235–45.

    Article  PubMed  Google Scholar 

  20. Rosoff DB, Davey Smith G, Mehta N, Clarke TK, Lohoff FW. Evaluating the relationship between alcohol consumption, tobacco use, and cardiovascular disease: a multivariable Mendelian randomization study. PLoS Med. 2020;17(12):e1003410.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kamarck TW, Li X, Wright AGC, Muldoon MF, Manuck SB. Ambulatory blood pressure reactivity as a moderator in the association between daily life psychosocial stress and carotid artery atherosclerosis. Psychosom Med. 2018;80(8):774–82.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hinterdobler J, Schott S, ** H, Meesmann A, Steinsiek AL, Zimmermann AS, et al. Acute mental stress drives vascular inflammation and promotes plaque destabilization in mouse atherosclerosis. Eur Heart J. 2021;42(39):4077–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Clarkson TB. Estrogen effects on arteries vary with stage of reproductive life and extent of subclinical atherosclerosis progression. Menopause. 2018;25(11):1262–74.

    Article  PubMed  Google Scholar 

  24. Sasaki Y, Ikeda Y, Miyauchi T, Uchikado Y, Akasaki Y, Ohishi M. Estrogen-SIRT1 axis plays a pivotal role in protecting arteries against menopause-induced senescence and atherosclerosis. J Atheroscler Thromb. 2020;27(1):47–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Hurtubise J, McLellan K, Durr K, Onasanya O, Nwabuko D, Ndisang JF. The different facets of dyslipidemia and hypertension in atherosclerosis. Curr Atheroscler Rep. 2016;18(12):82.

    Article  PubMed  Google Scholar 

  26. Leong XF, Ng CY, Jaarin K. Animal models in cardiovascular research: hypertension and atherosclerosis. Biomed Res Int. 2015;2015:528757.

  27. Poznyak AV, Sadykhov NK, Kartuesov AG, Borisov EE, Melnichenko AA, Grechko AV, et al. Hypertension as a risk factor for atherosclerosis: cardiovascular risk assessment. Front Cardiovasc Med. 2022;9:959285.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ni T, Fu Y, Zhou W, Chen M, Shao J, Zhou W, et al. Carotid plaques and neurological impairment in patients with acute cerebral infarction. PLoS ONE. 2020;15(1):e0226961.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Kianoush S, Yakoob MY, Al-Rifai M, DeFilippis AP, Bittencourt MS, Duncan BB, et al. Associations of cigarette smoking with subclinical inflammation and atherosclerosis: ELSA-Brasil (The Brazilian Longitudinal Study of Adult Health). J Am Heart Assoc. 2017;6(6):e005088.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Stein JH, Smith SS, Hansen KM, Korcarz CE, Piper ME, Fiore MC, et al. Longitudinal effects of smoking cessation on carotid artery atherosclerosis in contemporary smokers: the Wisconsin Smokers Health Study. Atherosclerosis. 2020;315:62–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Mahajan H, Choo J, Masaki K, Fujiyoshi A, Guo J, Hisamatsu T, et al. Association of alcohol consumption and aortic calcification in healthy men aged 40–49 years for the ERA JUMP Study. Atherosclerosis. 2018;268:84–91.

    Article  CAS  PubMed  Google Scholar 

  32. Kim MK, Shin J, Kweon SS, Shin DH, Lee YH, Chun BY, et al. Harmful and beneficial relationships between alcohol consumption and subclinical atherosclerosis. Nutr Metab Cardiovasc Dis. 2014;24(7):767–76.

    Article  CAS  PubMed  Google Scholar 

  33. Zheng Y, Yu B, Alexander D, et al. Metabolomic patterns and alcohol consumption in African Americans in the Atherosclerosis Risk in Communities Study. Am J Clin Nutr. 2014;99(6):1470–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Du R, Li M, Wang X, Wang S, Li S, Tian H, et al. LDL-C/HDL-C ratio associated with carotid intima-media thickness and carotid plaques in male but not female patients with type 2 diabetes. Clin Chim Acta. 2020;511:215–20.

    Article  CAS  PubMed  Google Scholar 

  35. Inukai T, Yamamoto R, Suetsugu M, Matsumoto S, Wakabayashi S, Inukai Y, et al. Small low-density lipoprotein and small low-density lipoprotein/total low-density lipoprotein are closely associated with intima-media thickness of the carotid artery in type 2 diabetic patients. J Diabetes Complications. 2005;19(5):269–75.

    Article  PubMed  Google Scholar 

  36. Huang J, Gu JX, Bao HZ, Li SS, Yao XQ, Yang M, et al. Elevated serum small dense low-density lipoprotein cholesterol may increase the risk and severity of coronary heart disease and predict cardiovascular events in patients with type 2 diabetes mellitus. Dis Markers. 2021;5597028.

  37. Kozakova M, Morizzo C, Fraser AG, Palombo C. Impact of glycemic control on aortic stiffness, left ventricular mass and diastolic longitudinal function in type 2 diabetes mellitus. Cardiovasc Diabetol. 2017;16(1):78.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Vergès B. Is reduction of hyperglycemia associated with a cardiovascular benefit. Presse Med. 2018;47(9):764–8.

    Article  PubMed  Google Scholar 

  39. Taylor R, Al-Mrabeh A, Sattar N. Understanding the mechanisms of reversal of type 2 diabetes. Lancet Diabetes Endocrinol. 2019;7(9):726–36.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge the help of all patients and researchers who contributed to this study.

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Authors and Affiliations

  1. Department of Endocrinology and Rheumatology, The First People’s Hospital of Lin** District, 369 Yingbin Road, Hangzhou, 311100, China

    **aohuan Chen, Yulan Hu, Huanhuan Ma, Zhonghua Jiang & Bo Lou

  2. Department of Nephrology, Haining People’s Hospital, 2 West Qianjiang Road, Jiaxing, 314400, China

    Jiacheng Shi

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  1. **aohuan Chen
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Contributions

XHC and JCS analyzed the data, drew the diagrams, and drafted the article. YLH and HHM performed data analysis and generated graphs. XHC and BL obtained the clinical data and revised the manuscript. XHC and ZHJ contributed to the design of the research and helped to write the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to **aohuan Chen.

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Ethical approval

This study was approved by Ethical Committee of The first People’s Hospital of Lin** District in Hangzhou, China. All research was performed in accordance with relevant guidelines. Informed consent was obtained from all participants and/or their legal guardians.

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The authors declare no conflicts of interest to disclose.

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Chen, X., Shi, J., Hu, Y. et al. Study on risk factors of carotid atherosclerosis in type 2 diabetes mellitus and development of prediction model. Int J Diabetes Dev Ctries (2024). https://doi.org/10.1007/s13410-024-01355-z

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