Carotid Intimal Media Thickness as an Indicator of Ischemic Heart Disease in Male Patients with Type 2 Diabetes and Metabolic Syndrome

BACKGROUND: Metabolic syndrome (MetS) increases cardiovascular disease risk due to accelerated atherosclerosis. Carotid intima-media thickness (CIMT) is an effective, noninvasive screening tool for atherosclerosis. Hence, we sought to measure the CIMT of male patients with type 2 diabetes and MetS and attempted to correlate the CIMT values between patients with and without evidence of ischemic heart disease. MATERIALS AND METHODS: This was a cross-sectional study conducted on diabetic patients who met the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for MetS (specified for the Indian population), aged 45-60 years. Each participant completed the Rose questionnaire and was grouped as either symptomatic or asymptomatic. Further, all patients were subjected to biochemical tests, electrocardiography (ECG), CIMT, echocardiography (ECHO), and ankle-brachial pressure index (ABPI). Those who showed no evidence of ischemia on ECG and ECHO were subjected to exercise stress testing (treadmill test). Abnormal ECG, ECHO, and treadmill test results indicating ischemic heart disease were used to group patients into ischemic and nonischemic groups. RESULTS: A total of 128 patients who met the inclusion criteria were recruited. The values of CIMT ranged from 0.62 to 0.76 mm. The CIMT values between the ischemic and nonischemic groups were found to be similar. However, CIMT values were consistently higher in patients with MetS compared to the general population CIMT values based on prior studies in India across all age-groups. The Rose questionnaire served as a good screening tool, with a negative predictive value of 86% for the detection of ischemia in asymptomatic patients. Among the other parameters, the critical value of ABPI was found to be higher in the ischemic group [1.1 (1-1.12) vs 1 (0.85-1.075), CONCLUSION: While CIMT was not a reliable indicator of ischemic heart disease in patients with MetS, its consistently elevated values compared to those of the general population suggest that it could serve as a valuable marker of atherosclerosis. The ankle-brachial pressure index (ABPI) has consistently proven to be a reliable and repeatable indicator of ischemia. Due to the high incidence of silent ischemia in this study group (12.9%), further research on early markers of ischemia and atherosclerosis is warranted.