Diabetes mellitus, cerebrovascular profile, and cognitive decline: The Carotid Artery Multi-modality imaging Prognostic study

Background The assessment of vascular remodeling and qualitative atherosclerotic plaque features may improve risk stratification and help identify patients with carotid artery disease and diabetes requiring closer follow-up and intensified preventive strategies. Purpose To characterize the cerebrovascular and cognitive profile of patients with type 2 diabetes and assess its association with cerebrovascular disease progression in asymptomatic carotid artery disease. Methods The Carotid Artery Multi-modality Imaging Prognostic (CAMP ACTIVE) Study enrolled patients with asymptomatic, mild-to-moderate (40-60%) carotid artery stenosis without atrial fibrillation. This preliminary analysis included 157 patients (48 with diabetes, 30.6%) with complete cerebrovascular and cognitive data. High-risk carotid plaque features (intraplaque hemorrhage, lipid-rich necrotic core and ulceration) were detected at magnetic resonance and computed tomography angiography. Markers of vascular remodeling included carotid-femoral pulse wave velocity and carotid augmentation index. Cognitive function was evaluated using a standardized neurocognitive test battery, with cognitive impairment defined as performance below the outer 5% tolerance limits (Ref. 1). Silent cerebrovascular disease at baseline was classified as non-lacunar brain infarcts or cerebral small vessel disease based on imaging review. Univariable logistic regression tested the association between baseline characteristics and the incidence of silent cerebrovascular lesions at two-year follow-up (n=91 completed follow-up). Results Compared to non-diabetic patients, diabetic patients had an increased prevalence of lower extremity artery disease (LEAD) and prior myocardial infarction (21% vs 9%, p = 0.046; 27% vs 8%, p = 0.002, respectively), along with greater arterial stiffness, reflected by higher pulse wave velocity (12 [10–13] vs 10 [9–12] m/s, p = 0.002) (Table 1). Cognitive function was significantly impaired in diabetic patients (Figure 1), particularly in episodic memory (34% vs 11%, p <0.05), visuospatial function (Clock Drawing Test 1: 56% vs 18%, p <0.05), and executive function (TMT B-A: 19% vs 12%, p <0.05). At follow-up, fourteen patients had new cerebrovascular lesions. At univariable analysis, diabetes mellitus was significantly associated with cerebrovascular disease progression, while alcohol consumption (≥2 units/day), LEAD, prior myocardial infarction, pulse wave velocity, and dyslipidemia were associated with a nominally higher risk of cerebrovascular disease (Figure 1). Conclusions Patients with diabetes and asymptomatic carotid artery disease exhibit a higher prevalence of systemic vascular disease, increased arterial stiffness, and greater cognitive impairment. Diabetes is associated with cerebrovascular disease progression, highlight the potential role of vascular remodeling and cognitive dysfunction as early markers of cerebrovascular risk. Figure 1