Negative Carotid Artery Remodeling in Early Type 2 Diabetes Mellitus and Increased Carotid Plaque Vulnerability in Obesity as Assessed by Magnetic Resonance Imaging

BACKGROUND: Ischemic stroke from carotid plaque embolism remains a major cause of morbidity in patients with type 2 diabetes mellitus (T2DM). However, the effect of early T2DM and obesity on carotid remodeling and plaque burden remains elusive. We assessed carotid remodeling and plaque composition by carotid magnetic resonance imaging in patients with short‐duration T2DM compared with a sex‐ and age‐matched control group. METHODS AND RESULTS: One hundred patients with T2DM (duration <5 years) and 100 sex‐ and age‐matched controls underwent bilateral carotid artery magnetic resonance imaging in a 1.5‐T magnetic resonance imaging scanner. Plaque burden was quantified by normalized wall index, maximum wall thickness, maximum wall area, and minimum lumen size. Plaque morphology was quantified by calcified plaque volume, necrotic core volume, and loose matrix volume. Magnetic resonance imaging data were available for 149 and 177 carotid arteries from T2DM patients and controls, respectively. Adjusted for age and sex, T2DM was associated with increased plaque burden indicated by a higher normalized wall index (ratio 1.03 [95% confidence interval, 1.002; 1.06], P=0.03), and negative remodeling indicated by a lower minimum lumen area (ratio 0.81 [0.74; 0.89], P<0.001), and lower maximum wall area (ratio 0.94 [0.88; 1.00], P=0.048) compared with controls. In both T2DM and controls, body mass index ≥30.0 kg/m(2) was associated with an 80% increase in total calcified plaque volume, and a 44% increase in necrotic core volume compared with body mass index <25.0 kg/m(2). CONCLUSIONS: Short‐duration T2DM was associated with increased carotid plaque burden and negative remodeling. Obesity was associated with increased carotid artery necrotic core volume and calcification independently of diabetes mellitus status. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00674271.