Duration of diabetes, glycemic control and intracranial atherosclerotic plaque vulnerability.

Abstract

Background: Intracranial vulnerable plaque, characterized by intraplaque hemorrhage (IPH), surface irregularity, positive remodeling, and plaque enhancement, is associated with cerebrovascular events. History of diabetes mellitus (DM) was reported to be a potential predictor of plaque vulnerability, but the predictive value of DM-related variables for it is still uncertain. The purpose of this study was to investigate the association of diabetes duration and glycemic control with symptomatic plaque vulnerability, in comparison to non-diabetic patients.

Methods: We retrospectively included a total of 220 patients who presented with ischemic stroke or transient ischemic attacks (TIA) underwent 3 T high-resolution magnetic resonance vessel wall imaging within 4 weeks of the onset of symptoms. The culprit plaque characteristics including morphology (positive remodeling and surface irregularity) and activation (IPH and plaque enhancement) were evaluated. We used multivariable logistic regression analyses to assess the differences of duration of diabetes (≥10 years compared with < 10 years) and glycemic control (HbA1c values ≥ 7.0 % compared with < 7.0 %) in plaque characteristics.

Results: The sample (n = 220) had a mean age of 56.6 ± 11.9 years and was 46.4 % of diabetes. Of the 102 DM individuals, 58.8 % had been with DM duration < 10 years (Short-DM group) and 41.2 % with duration ≥ 10 years (Long-DM group). The well-controlled group (HbA1c values < 7.0 %) and poor-controlled DM group (HbA1c values ≥ 7.0 %) included 31 (30.4 %) and 71 (69.6 %) patients, respectively. We found significant difference in positive remodeling between patients with DM duration < 10 years and ≥ 10 years (adjusted odds ratio [OR] = 2.9 [95 % CI, 1.2-6.9]). Compared with patients who had HbA1c < 7.0 %, poor glycemic control was significantly associated with an increased rate of IPH (adjusted OR = 9.14 [95 % CI, 2.66-31.33]), plaque enhancement (adjusted OR = 3.09 [95 % CI, 1.02-9.34]), and surface irregularity (adjusted OR = 2.72 [95 % CI, 1.04-7.11]). Both patients with duration ≥ 10 years (adjusted OR = 3.84 [95 % CI, 1.31-11.24]) and patients HbA1c ≥ 7.0 % (adjusted OR = 3.41 [95 % CI, 1.33-8.76]) had more often coexistence of all vulnerable plaque characteristics compared with nondiabetic patients.

Conclusion: Increased durations of diabetes and poor glycemic control are both independently associated with existence and coexistence of intracranial atherosclerotic plaque vulnerability, which should be considered when stratifying risk among patients with intracranial atherosclerosis.