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38
VOLUME 9 NUMBER 1 • MARCH 2012
REPORT
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Relationship between adiponectin
and carotid IMT
Serum adiponectin, one of the most com-
monly occurring adipokines, has been
shown to be associated with cardiovascu-
lar disease and related risk factors. In the
first communication of this series, Dr Paul
Lee, on behalf of his colleagues from the
University of Hong Kong (China), presented
the results of their study on the association
of serum adiponectin with carotid intima–
media thickness (IMT), a well-known surro-
gate marker of cardiovascular disease.
Participants were 269 adults (132 men),
all members of the Hong Kong Cardio-
vascular Risk Factors Prevalence Study 2
(CRISPS 2) cohort. CRISPS 2 was a commu-
nity-based cohort study conducted from
2000 to 2004 as a follow up of a repre-
sentative community-based survey (CRISPS
1) carried out from 1995 to 1996.
Serum adiponectin, IMT and cardiovas-
cular risk factors were measured at base-
line. Mean age of participants was 53 ± 12
years; 91 had hypertension and 33 had dia-
betes. Median (interquartile range) baseline
adiponectin level was 5.28 mg/l (3.29–
7.93). During the first five years of follow
up, carotid IMT significantly increased from
0.62 mm (0.52–0.73) to 0.67 mm (0.57–
0.78) (
p
< 0.001).
In linear regression analysis, after adjust-
ment for several baseline covariates, the
investigators found a modest association
between low baseline adiponectin levels and
IMT thickening (
β
= –0.092,
p
= 0.039).
The investigators concluded that meas-
uring adiponectin level would improve
cardiovascular disease risk stratification at
the community level. The study was how-
ever based on a small sample size, and the
investigators did not use measures of global
performance to assess the contribution of
adiponectin level to risk prediction.
Oxidative stress and vascular
complications of diabetes
There is accumulating evidence on the
important role of oxidative stress on vas-
cular complications of diabetes mellitus. Dr
Iso gave a talk on behalf of her colleagues
from the School of Medicine, Toho Univer-
sity in Japan, on components of oxidative
stress associated with carotid IMT in people
with diabetes.
In all, they included 52 diabetic patients
(17 women) with acceptable levels of
control of blood glucose and blood pres-
sure on a cross-sectional basis. They were
non-smokers and had non-ongoing acute
or chronic inflammatory disease, kidney
impairment or liver disease.
Urine levels of 8-hydroxydeoxygua-
nosine (8-OHdG, a marker of oxidative
DNA damage) and 8-epiprostaglandin
F2a (PGF2-a, a marker of lipid peroxida-
tion), both makers of oxidative stress, were
measured together with inflammatory
markers [high-sensitivity C-reactive protein
(hs-CRP)] and other clinical and biological
parameters. Maximum IMT (max-IMT) was
measured by ultrasonography. Mean age
and duration of diabetes were 52 and five
years, respectively.
In univariate linear regression analysis,
age and PGF2-a were the main charac-
teristics associated with max-IMT. These
associations were borderline in multivariate
analysis.
The authors concluded that in diabetic
subjects with acceptable metabolic con-
trol, oxidative stress may be implicated in
the progression of atherosclerosis in people
with diabetes. This claim however was
based on a small sample size and border-
line association in a cross-sectional design.
Visceral fat and cardiovascular risk
in a Chinese study
Body fat is a determinant of cardiovascular
disease risk, and there are suggestions that
the distribution of body fat may contribute
differentially to this risk. This presentation
from a group of researchers from Shanghai
Jiao Tong University in China was delivered
by Dr Ma on the contribution of visceral
fat accumulation to carotid IMT in a group
of 1 005 Chinese adults. Carotid IMT was
quantified by ultrasonography, and visceral
(VFA) and subcutaneous fat (SFA) were
characterised through magnetic resonance
imaging.
In multiple regression analysis, waist cir-
cumference (an indicator of body fat dis-
tribution) was associated with IMT while
body mass index, a measure of the overall
fat mass, was not. Similarly, VFA, a more
accurate indicator of body fat distribution,
was associated with IMT, while SFA was
not.
The authors suggested that their find-
ings were in agreement with reports from
other studies in the USA and Korea, and
concluded that VFA was effective in identi-
fying atherosclerosis in both lean and obese
individuals. Since other more reliable meth-
ods for quantifying atherosclerosis already
exist, this study extends previous findings
from other settings to China and confirms
the thesis of differential contribution of
body fat distribution to disease risk.
Gastrectomy and atheroscerlosis
progression
This presentation was from a group of
investigators from the Centre for Diabe-
tes and Endocrinology of Kitano Hospital
in Osaka (Japan) and was delivered by Dr
Wada. They investigated the effects of gas-
trectomy on progression of atherosclerosis
in adults with diabetes.
They recruited 157 patients with type 2
diabetes, among whom 20 had undergone
a gastrectomy at least five years previously
for cancer eradication. Carotid IMT and
other clinical and biological parameters
were assessed.
Participants with gastrectomy had
higher systolic blood pressure, and lower
HbA
1c
and LDL cholesterol levels, compared
to those without gastrectomy. Other clini-
cal characteristics were similar between
the two groups. Mean carotid IMT was
significantly lower in the gastrectomised
group than in those without gastrectomy
(
p
= 0.04). This difference persisted in some
subgroup analyses (smokers, patients with
hypertension), but not in all. Subgroup
analyses however, were based on small
numbers.
The authors concluded that in addition
to the known beneficial effects of gast-
rectomy on glucose tolerance, this pro-
cedure may also have a favourable effect
on the progression of atherosclerosis. The
study, as recognised by the investigators,
was cross-sectional and based on a small
sample size.
Sagittal abdominal diameter a
better predictor of arterial stiffen-
ing than waist circumference
Ostgren and his collaborators from Linkop-
ing University in Sweden demonstrated a
finding suggesting that sagittal abdomi-
nal diameter (SAD) was a better predictor
of arterial stiffening than waist circumfer-
ence (WC) in people with diabetes. This
was based on 255 participants with type 2
diabetes, members of the CARDIPP cohort
(CArdiovascular Risk factors in people with
Diabetes – a Prospective study in Primary
care).