Key result
Diabetes was associated with higher carotid plaque K trans compared to no diabetes (0.100 vs 0.067 min-1, P=0.005), an association that became nonexistent after adjusting for hemoglobin A1c.
Why the study?
Patients with diabetes have accelerated atherosclerosis progression, but the underlying mechanisms remain incompletely understood.
Is diabetes or elevated hemoglobin A1c associated with leaky plaque neovasculature in patients with recent ischemic stroke and carotid plaque?
Observational (n=65)
Is diabetes or elevated hemoglobin A1c associated with leaky plaque neovasculature in patients with recent ischemic stroke and carotid plaque?
Effect estimate: β=0.033
Absolute Event Rate: 0.1% vs 0.067%
p-value: p=0.005
Elevated hemoglobin A1c in patients with diabetes is associated with leaky carotid plaque neovasculature on dynamic contrast-enhanced MRI, which may contribute to accelerated atherosclerosis progression.
HbA1c-linked leaky neovasculature may heighten plaque vulnerability in diabetic stroke patients; leaves open causal mechanisms and need for prospective validation.
Background: Patients with diabetes have accelerated atherosclerosis progression, but the underlying mechanisms are not fully understood. Dynamic contrast-enhanced magnetic resonance imaging has allowed in vivo characterization of plaque neovasculature, which plays a critical role in plaque progression. We aimed to evaluate the impact of diabetes on carotid plaque neovasculature as assessed by dynamic contrast-enhanced magnetic resonance imaging. Methods: Patients with recent ischemic stroke and ipsilateral carotid plaque underwent multicontrast magnetic resonance imaging for characterizing plaque morphology and dynamic contrast-enhanced magnetic resonance imaging for pharmacokinetic parameters of plaque neovasculature, including transfer constant ( K trans , reflecting flow, endothelial surface area, and permeability) and fractional plasma volume ( ν p ). Results: Sixty-five patients were enrolled, including 30 patients with diabetes (years since diagnosis: median 5.0 [interquartile range, [3.0–12.0]) and 35 patients without diabetes. Subjects with diabetes had a greater plaque burden and a higher prevalence of high-risk characteristics. Additionally, carotid plaques in the subjects with diabetes showed higher K trans than those in the subjects without diabetes (0.100±0.048 min -1 versus 0.067±0.042 min -1 , P =0.005) but ν p was numerically lower in the subjects with diabetes (5.2±3.7% versus 6.2±4.3%, P =0.31). The association of diabetes with high K trans (β=0.033, P =0.005) was independent of patient and plaque characteristics and remained largely intact after adjusting for serum lipids, glucose, or hs-CRP (high-sensitivity C-reactive protein). However, it became nonexistent after adjusting for hemoglobin A1c (β=−0.010, P =0.49). Conclusions: Dynamic contrast-enhanced magnetic resonance imaging of carotid plaques suggested that plaque neovasculature in patients with diabetes is leaky, indicating enhanced capability of bringing blood constituents and facilitating extravasation of inflammatory cells, erythrocytes, and plasma proteins. Leaky plaque neovasculature correlated with hemoglobin A1c and may play a role in accelerated atherosclerosis progression in diabetes.
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A 2022 study conducted an observational in Recent ischemic stroke and ipsilateral carotid plaque (n=65). Diabetes vs. Without diabetes was evaluated on K trans (transfer constant) of carotid plaque neovasculature (β=0.033, p=0.005). Diabetes was associated with higher carotid plaque K trans compared to no diabetes (0.100 vs 0.067 min-1, P=0.005), an association that became nonexistent after adjusting for hemoglobin A1c.
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