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Background: Vascular disease, including coronary heart disease (CAD), peripheral vascular disease and cerebrovascular disease, is the major cause of morbidity and death in diabetes. A recently introduced MRI technique was used to obtain an extensive assessment (excluding coronaries) of the vascular status in 65 diabetic patients. Methods: Long-standing ≥10 years) type 1 (n=20) or type 2 (n=45) diabetic patients (35 males, 63±13.1 years) were examined on a 1.5 Tesla or 3.0 Tesla whole body MRI. Cerebral arteries, abdominal aorta, and arteries of the upper and lower extremities (including pedal arteries) were imaged in one session (MR angiogram). Atherosclerotic lesions were quantified in each vessel (6 levels ranging from normal to occlusion) and the sum divided by the number of vessels evaluated resulted in an overall score, representing the patient's vascular status. The score's association with clinical and biochemical parameters was assessed with a generalized linear model (age and sex adjusted; SAS 9.1). Results: Age (p=0.0008) and male sex (p=0.029) were significantly associated with the score (r²=0.23). Adjusted for age and sex, the score was also associated with CAD status (r²=0.32; p=0.005), retinopathy (r²=0.31; p=0.007), serum creatinine (r²=0.34; p=0.006) and somewhat with diabetes duration (r²=0.26; p=0.07). BMI, blood pressure, smoking, type of diabetes, HbA1c, LDL-concentration and medications were not associated with the score. Conclusion: Our MRI based score evaluating vascular pathology (without coronaries) is significantly associated with CAD status, indicating that atherosclerosis has a similar etiology in coronary, cerebral and peripheral arteries in diabetes. Age, male sex, retinopathy, nephropathy (and perhaps duration of diabetes) are important predictors of an elevated score, indicating high atherosclerotic burden. BMI, blood pressure, HbA1c, LDL, and medications were not important predictors (probably because single on-treatment measurements were used). Whole-body MRI is a promising method for comprehensive atherosclerotic evaluation in diabetes. [ABSTRACT FROM AUTHOR]

Atherothrombosis can present as coronary artery disease (CAD), cerebrovascular disease (CVD) and peripheral arterial disease (PAD). It is unknown whether diabetic patients with CAD differ from those with CVD or PAD regarding clinical characteristics, biochemical parameters and medication. The REACH (REduction of Atherothrombosis for Continued Health) Registry contains data on over 68,000 patients with atherosclerosis or risk factors. The registry's primary goal is to evaluate vascular endpoints. In total, 5646 patients were recruited in Germany, 2390 (42%) of which are diabetic. Of these, 852 (36%) have only CAD, 286 (12%) have only CVD and 176 (7%) have only PAD. The others have either only risk factors (18%) or multiple manifestations (27%). The baseline data of diabetic patients (80% male, 68 ± 9 years, BMI 129 ± 5 kg/m²) with only CAD, or CVD, or PAD were evaluated (generalized linear model for continuous dependent variables, logistic regression for dependent variables with 2 classes; SAS). After correcting for age, sex and BMI, CAD patients receive (OR; 95% CI) statins (4.1; 2.9-5.9), beta-blockers (4.1; 4.9-10.5), diuretics (1.9; 1.3-2.6) and nitrates (8.7; 4.5-16.8) significantly more frequently and significantly less calcium-antagonists (0.73; 0.55-0.98). There was no difference concerning other antihypertensives, antidiabetics and platelet inhibitors. Medication differences resulted in significant ((*) p<0.05) differences between CAD compared to CVD and PAD regarding clinical and laboratory parameters (Table). Overall only few patients (CAD 9.5%, CVD 8.5%, PAD 0%) reach all treatment goals (BP-systolic ≤130mmHg, BP-diastolic ≤85mmHg, LDL≤100mg/dl, HDL≥40mg/dl, triglycerides ≤150mg/dl). These data indicate considerable differences in therapy between diabetics with CAD compared to those with CVD or PAD. Diabetics with CAD are treated more aggressively and therefore reach lower lipid values and lower blood pressure values. [ABSTRACT FROM AUTHOR]