Published online May 15, 2023. doi: 10.4239/wjd.v14.i5.594
Peer-review started: February 28, 2023
First decision: March 14, 2023
Revised: March 20, 2023
Accepted: April 12, 2023
Article in press: April 12, 2023
Published online: May 15, 2023
Processing time: 76 Days and 7.9 Hours
Intracranial and extracranial artery stenosis is associated with cerebral infarction. Vascular calcification and atherosclerosis are the main causes of stenosis and major risk factors for cardiovascular and cerebrovascular events in patients with type 2 diabetes mellitus (T2DM). Bone turnover biomarkers (BTMs) are associated with vascular calcification, atherosclerosis, glucose, and lipid metabolism.
To investigate the association of circulating BTM levels with severe intracranial and extracranial artery stenosis in patients with T2DM.
For this cross-sectional study including 257 T2DM patients, levels of the BTMs serum osteocalcin (OC), C-terminal cross-linked telopeptide of type I collagen (CTX), and procollagen type I N-peptide were measured by electrical chemiluminescent immunoassay, and artery stenosis was assessed by color Doppler and transcranial Doppler. Patients were grouped according to the existence and location (intracranial vs. extracranial) of artery stenosis. Correlations between BTM levels, previous stroke, stenosis location, and glucose and lipid metabolism were analyzed.
T2DM patients with severe artery stenosis had a higher frequency of previous stroke and levels of all three tested BTMs (all P < 0.05) than patients without. Some differences in OC and CTX levels were observed according to the location of artery stenosis. Significant associations were also observed between BTM levels and some glucose and lipid homeostasis parameters. On multivariate logistic regression analysis, all BTMs were significant predictors of artery stenosis in T2DM patients with and without adjustment for confounding factors (all P < 0.001), and receiver operating characteristic curve analysis demonstrated the ability of BTM levels to predict artery stenosis in T2DM patients.
BTM levels were found to be independent risk factors for severe intracranial and extracranial artery stenosis and were differentially associated with glucose and lipid metabolism in patients with T2DM. Therefore, BTMs may be promising biomarkers and potential therapeutic targets for artery stenosis.
Core Tip: The occurrence of cerebral infarction is associated with severe intracranial and extracranial artery stenosis; thus, this study aims to identify risk factors for severe intracranial and extracranial artery stenosis in patients with type 2 diabetes mellitus (T2DM) to prevent the occurrence of cerebral infarction. Our study found that Bone turnover biomarkers (BTMs) are associated with the risk of arterial stenosis, probably due to the relationship between BTMs and glucose and lipid metabolism disorders. Detection of BTMs in patients with T2DM may help reduce the occurrence of cardiovascular disease.