Study of influence of the duration of NIDDM on CCA-IMT

Introduction: The unprecedented increase in diabetes and cardiovasular disease (CVD) prevalence is evident from the report of WHO which shows that India tops the world with the largest number of subjects. All these data suggest that the epidemic of type 2 DM and CAD has already assumed alarming proportions and urgent measures are needed to stem it. With this view present work was planned to study of influence of the duration of NIDDM on CCA-IMT. Materials and Methods : From the diabetics who underwent coronary angiography in our institution, 20 patients having CAD and 20 patients having normal coronaries were selected. Each patient was subjected for carotid dopper to measure CCA-IMT during the same hospital stay. The sample size was estimated with the help of expert. Observations & results : There is highly significant difference in mean IMT between type II DM and non-diabetics. Conclusion: Present study shows greater the duration of NIDDM, greater the IMT in NIDDM. Introduction: The unprecedented increase in diabetes and cardiovasular disease (CVD) prevalence is evident from the report of WHO which shows that India tops the world with the largest number of subjects. According to recent WHO reports presently India has 32 million i.e. a rise by 250 % by the year 2035. Type 2 DM represents more than 90 % of the diabetic population. There is evidence from Indian data as well that coronary artery disease (CAD) is more common in diabetic subject. 2 Studies conducted in south India by Mohan et al and Ramchandran et al in Chennai showed a prevalence of diabetic varying from 12-16%. In a study done at MV Diabetes Centre, Madras the prevalence of CAD was assessed in a large cohort of 6597 NIDDM patients. Overall 17.8% of patients have CAD. Its prevalence was not significantly different in males and females. The Chennai Urban Population Study (CUPS) reported that overall CAD prevalence was 11%. 12% of this population was diabetic. Among these 21.4% had CAD, more than the double that of non-diabetics. 4 All these data suggest that the epidemic of type 2 DM and CAD has already assumed alarming proportions and urgent measures are needed to stem it. With this view present work was planned to study of influence of the duration of NIDDM on CCAIMT. Materials and Methods Study design From the diabetics who underwent coronary angiography in our institution, 20 patients having CAD and 20 patients having normal coronaries were selected. Each patient was subjected for carotid dopper to measure CCA-IMT during the same Indian Journal of Basic and Applied Medical Research; September 2014: Vol.-3, Issue4, P. 422-426 423 www.ijbamr. com P ISSN: 2250-284X , E ISSN : 2250-2858 hospital stay. The sample size was estimated with the help of expert. Similarly, from the non-diabetics who underwent coronary angioraphy, 20 patients having CAD and 20 patients having normal coronaries were selected. Each patient was subjected for carotied dopper during the same hospital stay. Criteria for inclusion : Patients in the age group of 45-65 yrs. Irrespective of sex, duration of DM, lipid profile, normotensive or hypertensive. CAD (Coronary Artery Diseases) is defined as more than 50% stenosis in one or more arteries on angiography. CCA (Common Carotid Artery) is defined as the 1 cm segment proximal to the dilatation of the carotid bulb. IMT (Intima-Media Thickness) The intimal plus medial thickness was measured as the distance from the leading edge of the first echogenic line to the second echogenic line. The first line represents the lumen intimal interface and the second line is produced by the collagen-containing upper layer of the intimal adventitia. Measurement of common carotid artery IMT Positions of the patient – Patient in supine position with pillow between the shoulder blades were kept to achieve extension of the neck. Tilting and rotating the head away from the side being examined enhanced neck exposure. Site – The Common carotid artery was defined as the 1 cm segment proximal to the dilatation of the carotid bulb. For each patient three measurements for intimamedia thickness (as defined above) on both sides on the anterior, lateral and Posterolateral projection of far wall readings were obtained. The mean of the six readings was used as the representative value for each subject. The mean IMT values on the left side were found to be higher as compared to the mean IMT value on the right side in the same patient. All the scanning was done by a single trained ultrasonologist who was unaware of the clinical status of the study subjects. Plaque is defined as an echogenic structure, having an IMT of more than 50% greater than that of surrounding sites and encroaching into the vessel lumen. Morphologically plaque classified as a. Predominantly echo lucent plaque with a thin echogenic cap. b. Substantially echo lucent with small areas of echogenicity. c. Predominantly echogenic with small areas of echogenicity. d. Uniformly echogenic I & II – Seen in symptomatic patients > 70% stenosis. III & IV – Benign plaques common in old people. Criteria for exclusion 1) Age < 45 yrs and > 65 yrs. 2) IDDM 3) Pregnant women 4) Patients on OCPs & long term steroids. 5) Renal / Liver disease. Indian Journal of Basic and Applied Medical Research; September 2014: Vol.-3, Issue4, P. 422-426 423 www.ijbamr. com P ISSN: 2250-284X , E ISSN : 2250-2858 Diabetic patients were also studied for CCA-IMT in relation to duration of NIDDM. According to duration of diabetes patients divided into 2 groups. Groups Duration of NIDDM