Ratio of Waist-To-Calf Circumference and Carotid Atherosclerosis in Patients of Type 2 Diabetes Mellitus.

AIM: Diabetes is a well known risk factor for carotid atherosclerosis. However, screening of all diabetics by carotid ultrasonography is cumbersome and cost-effective. Search for anthropometric measures related to severity of disease has been relentless. It's a proposal for waist-calf ratio as a better marker of carotid atherosclerosis than traditional measurements as it is cost-effective and non-invasive.

METHODS: This was a cross-sectional observational study. 100 patients were included. Detailed history, clinical examination, biochemical indices and anthropometric measurements were recorded. Carotid atherosclerosis was measured using a high resolution USG system with 10 MHz linear transducer. The carotid intima-media thickness (CIMT) was measured at 3 points on far wall of mid and distal CCA and 1 cm proximal to dilation of carotid bulb. Mean value of six measurements from right and left CCA was used. CIMT → Distance between media-adventitia interface and lumen intima interface. Carotid Plaque → distinct area of hyperechogenicity and or protrusion into the lumen of vessel with at least 50% greater thickness than the surrounding area. Carotid atherosclerosis → Focal plaque or CIMT > 1.1 mm.

RESULTS: Mean CIMT in quartiles of WCR in females and males are 1st (0.740, 0.674); 2nd (0.833, 0.726); 3rd (0.902, 0.814); 4th (1.005, 0.910) as well as mean WCR in quartiles of CIMT in males and females are 1st (2.292, 2.302); 2nd (2.473,2.443 ); 3rd (2.641, 2.671); 4th (3.177, 2.967). All the quartiles are statistically highly significant with p<0.001. Out of 100 patients 17 patients with carotid plaques, 12 had CIMT >1 and 14 had WCR >2.5. The difference was statistically significant with p<0.01.

CONCLUSIONS: waist-calf ratio is a stronger anthropometric marker of carotid atherosclerosis and can be used in screening of high risk patients in diabetic population.