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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2002 March;21(1):63-69

language: English

Atherosclerosis of carotid arteries and the ace insertion/deletion polymorphism in subjects with diabetes mellitus type 2

Diamantopoulos E. J., Andreadis E., Kakou M., Vlachonikolis I. ***, Vassilopoulos C., Giannakopoulos N., Tarassi K. **, Papasteriades C. **, Nicolaides A. ****, Raptis S. *

From the 4th Department of Internal Medicine,
* 2nd Department of Internal Medicine-Propaedeutic of the Athens University Medical School, and ** Histocompatibility Department of the "Evangelismos" State General Hospital, Athens, Greece
*** Department of Medical Statistics, Medical School, University of Crete, Crete, Greece
**** The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus and Department of Vascular Surgery Imperial College, London, UK

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Background. The aim of the ­present study was to inves­ti­gate the asso­ci­a­tion of the angio­ten­sin-con­vert­ing ­enzyme (ACE) insertion/deletion (I/D) poly­mor­phism with the ultra­son­o­graph­i­cal­ly eval­u­at­ed sever­ity and char­ac­ter­is­tics of carot­id ­artery ath­ero­scler­o­sis in sub­jects with dia­betes mel­lit­us type 2.
Methods. We ­assessed 184 sub­jects with dia­betes mel­lit­us type 2, 75 males and 109 ­females, mean age 61.4±7.7 years. All sub­jects were receiv­ing oral anti­di­a­bet­ic drugs for gly­cem­ic con­trol and were free of car­di­o­vas­cu­lar ­events. The ACE gen­o­type was ana­lyzed by the poly­me­rase chain reac­tion (PCR) tech­nique. The ultra­son­o­graph­ic exam­ina­tion of the carot­id arter­ies was per­formed in both B-mode imag­ing and Doppler ultra­sound. The com­mon carot­id ­artery inti­ma-media thick­ness was ­assessed 15-20 mm prox­i­mal to the dil­a­ta­tion of the carot­id bulb. The ath­e­rom­a­tous ­lesions were clas­si­fied accord­ing to their ech­o­gen­ic char­ac­ter­is­tics as pre­dom­i­nant­ly echol­u­cent, mixed and pre­dom­i­nant­ly ech­o­gen­ic with under 30, 30-70 and over 70% of the total ­plaque area echog­e­nic­ity, respec­tive­ly.
Results. From the total ­cohort 29 (15.8%) sub­jects had the II, 86 (46.7%) the ID and 69 (37.5%) the DD ACE gen­o­types. The mean carot­id ­artery diam­e­ter sten­o­sis was 37±17%, 43±19% and 40±20% (p=NS) and the inti­ma media thick­ness was 0.94±0.24 mm, 0.97±0.20 mm and 0.98±0.20 mm (p=NS) in the II, ID and DD sub­groups, respec­tive­ly. When the echog­e­nic­ity was ana­lyzed accord­ing to the ACE I/D poly­mor­phism, 12 sub­jects (41.4%), 13 (44.8%) and 4 (13.8%) with II gen­o­type had pre­dom­i­nant­ly ech­o­gen­ic, mixed and pre­dom­i­nant­ly echol­u­cent ­lesions, respec­tive­ly. The ID gen­o­type dia­bet­ics were found to have pre­dom­i­nant­ly ech­o­gen­ic ­plaques in 41 cases (47.7%), mixed in 30 (34.9%) and pre­dom­i­nant­ly echol­u­cent in 15 cases (17.4%). From the 69 DD sub­jects 19 (27.5%) had pre­dom­i­nant­ly ech­o­gen­ic ­plaques, 26 (37.7%) had mixed and 24 (34.8%) had pre­dom­i­nant­ly echol­u­cent ­lesions. Predominantly echol­u­cent ­plaques were more fre­quent­ly encoun­tered among dia­bet­ics with the DD gen­o­type (p<0.05), even after cor­rec­tion for dem­o­graph­ic char­ac­ter­is­tics, the main risk fac­tors of ath­ero­scler­o­sis and blood glu­cose con­trol.
Conclusions. The ACE gen­o­type seems to be asso­ciat­ed with the echog­e­nic­ity of carot­id ­artery ather­o­mat­o­sis but not with the com­mon carot­id ­artery inti­ma media thick­ness or the ­degree of inter­nal carot­id ­artery sten­o­sis in sub­jects with type 2 dia­betes mel­lit­us. The DD gen­o­type may be impli­cat­ed in the ­increased car­di­o­vas­cu­lar risk that char­ac­teriz­es echol­u­cent ­plaques.

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