Frequency of Increased Intimal-Medial Thickness in Patients with Type 2 Diabetes and Ischemic Stroke

Abstract

Background: Type 2 diabetes mellitus is strongly associated with macrovascular complications including ischemic stroke and is a rapidly growing health concern globally. Carotid intimal media thickness has been recognized as a reliable, noninvasive marker of early vascular changes and subclinical atherosclerosis often introduces clinically apparent cerebrovascular events. There is a scarcity of region-specific data from South Asia, particularly Pakistan, where genetic predisposition, lifestyle factors, and healthcare disparities may affect vascular risk, while international studies have explored carotid intimal media thickness (C-IMT) in diabetic populations. Objective: To determine the frequency of increased C-IMT in patients with type 2 diabetes mellitus (T2DM) presenting with acute ischemic stroke was the aim of this study was in Pakistan and to explore the metabolic factors and clinical associated with this subclinical vascular marker. Methods: This cross-sectional study was conducted in the Department of Diagnostic Radiology at Lahore General Hospital, Lahore, over a 6-month period. After fulfilling inclusion and exclusion criteria, a total of 100 patients aged 30 to 70 years, diagnosed with T2DM and presenting with first ever, radiologically confirmed acute ischemic stroke were enrolled in this study. For recruitment non probability consecutive sampling was used. Clinical variables and sociodemographic like age, gender, body mass index (BMI), hypertension, smoking status, and duration of diabetes, were recorded. HbA1c, fasting lipid profile, and serum creatinine laboratory investigations that performed. In both common carotid arteries, avoiding plaque regions Carotid IMT was measured using a Philips EPIQ 7G ultrasound machine with a 12–3 MHz linear transducer, at three standardized points. Increased IMT was defined as a mean value >0.9 mm. Using SPSS v26, employing descriptive statistics, comparative tests (Chi-square), and correlation analyses (Pearson) with significance set at p<0.05 statistical analysis was conducted. Results: Among diabetic stroke patients, the study revealed that a significant majority of participants exhibited increased C-IMT, showing a high prevalence of subclinical carotid atherosclerosis. With increased IMT age, poor glycemic control (elevated HbA1c), dyslipidemia (high triglycerides and low HDL cholesterol), hypertension, and longer duration of diabetes were found to be significantly associated. In this cohort study, the observed frequency was higher than reports from other countries, potentially reflecting genetic susceptibility, suboptimal diabetes management, delayed healthcare access, and lifestyle factors unique to the Pakistani population. Conclusions: In this high-risk population, increased C-IMT is highly prevalent among Pakistani patients with T2DM presenting with acute ischemic stroke, emphasizing the silent yet progressive nature of subclinical atherosclerosis. For early vascular changes, the study supports the value of C-IMT as a non-invasive marker and underscores the importance of comprehensive risk assessment in diabetic patients.