Cardiovascular risk assessment in diabetes

Abstract

Research described in this thesis is based on clinical data obtained through diabetes cardiovascular risk management (DIACARM) project. A clinical protocol founded on the co-operation of the departments of endocrinology, cardiology, nephrology, radiology and nuclear medicine at the Leiden University Medical Center. This protocol is set to improve medical care at patient and provide more insight into cardiovascular risk stratification in asymptomatic patients with diabetes. The first part of the thesis focuses on the nature of coronary artery disease in diabetes, and its presentation with different imaging modalities. The relation between epicardial adipose tissue and plasma biomarkers with coronary atherosclerosis were investigated. Furthermore, extent and morphology of atherosclerosis are compared in patients with type 1- and type 2 diabetes. In the second part of the thesis the value of non-invasive vascular measurements (carotid intima media thickness, pulse wave velocity) and cardiac imaging techniques were evaluated and compared for risk stratification of coronary artery disease in diabetes. The final part of the thesis describes a novel technique, sidestream dark field imaging, for the assessment of the microcirculation at capillary level. Parameters of microcirculation were shown to have a relation with coronary artery disease in diabetes