Quantitative evaluation of the effect of hyperlipidemia on carotid artery stiffness in patients with type 2 diabetes mellitus using shear wave elastography

Type 2 diabetes mellitus (T2DM) is a major risk factor for atherosclerotic cardiovascular disease (CVD), and hyperlipidemia (HLD) frequently coexists. Shear wave elastography (SWE) quantifies carotid stiffness and may improve CVD risk stratification. To evaluate the impact of HLD on carotid stiffness in T2DM using SWE. We conducted a cross-sectional study of 112 adults with T2DM: simple diabetes (Group B, n = 52) and T2DM with HLD (Group C, n = 60): and 55 healthy controls (Group A). Demographic, clinical, and biochemical data were collected. Conventional ultrasound measured carotid intima-media thickness, diastolic diameter, systolic diameter, and peak systolic velocity. Arterial distensibility and the stiffness coefficient were calculated. SWE provided maximum, mean, and minimum elastic moduli. Pearson correlation tested associations between SWE parameters and risk factors; multivariable linear regression identified independent determinants of SWE values. Compared with controls, Groups B and C had higher fasting glucose, glycated hemoglobin, total cholesterol (TC), triglycerides (TG), and LDL-C (all P < .05); TC, TG, and LDL-C were higher in Group C than Group B (all P < .05). high-density lipoprotein cholesterol (HDL-C) were lower in both Group B and Group C compared to Group A (both P < .05), and were also lower in Group C than in Group B (P < .05). Mean elastic modulus, maximum elastic modulus, and minimum elastic modulus were greater in Groups B and C than in controls and were highest in Group C (all P < .05). SWE parameters correlated positively with carotid intima-media thickness, TC, TG, and LDL-C, and negatively correlated with HDL-C (all P < .05). In multivariable models, hyperlipidemia: driven primarily by elevated TC, TG, and LDL-C and reduced HDL-C: was independently associated with increased SWE values in T2DM (all P < .05). HLD exacerbates carotid atherosclerosis in T2DM. SWE is a noninvasive, quantitative, and efficient method for assessing carotid stiffness and cardiovascular risk in T2DM, particularly among patients with concurrent HLD.