Use of imaging and clinical data to screen for cardiovascular disease in asymptomatic diabetics

There is increasing evidence to suggest that not all individuals with type 2 diabetes mellitus (T2DM) have equal risk for developing cardiovascular disease. We sought to compare the yield of testing for pre-clinical atherosclerosis with various approaches. 98 asymptomatic individuals with T2DM witho...

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Published in:	Cardiovascular diabetology Vol. 15; no. 1; p. 28
Main Authors:	Rassi, Carlos Henrique Reis Esselin, Churchill, Timothy W, Tavares, Carlos A Fernandes, Fahel, Mateus Guimaraes, Rassi, Fabricia P O, Uchida, Augusto H, Wajchenberg, Bernardo L, Lerario, Antonio C, Hulten, Edward, Nasir, Khurram, Bittencourt, Márcio S, Rochitte, Carlos Eduardo, Blankstein, Ron
Format:	Journal Article
Language:	English
Published:	England BioMed Central 09-02-2016
Subjects:	Adult Aged Asymptomatic Diseases Brazil Carotid Artery Diseases - diagnostic imaging Carotid Artery Diseases - epidemiology Carotid Artery Diseases - physiopathology Carotid Intima-Media Thickness Coronary Angiography Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - epidemiology Coronary Artery Disease - physiopathology Coronary Stenosis - diagnostic imaging Coronary Stenosis - epidemiology Coronary Stenosis - physiopathology Coronary Vessels - diagnostic imaging Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - epidemiology Diagnostic Imaging - methods Exercise Test Female Humans Male Mass Screening - methods Middle Aged Original Investigation Plaque, Atherosclerotic Predictive Value of Tests Prevalence Prognosis Prospective Studies Reproducibility of Results Tomography, X-Ray Computed Vascular Calcification - diagnostic imaging Vascular Calcification - epidemiology Vascular Calcification - physiopathology
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Summary:	There is increasing evidence to suggest that not all individuals with type 2 diabetes mellitus (T2DM) have equal risk for developing cardiovascular disease. We sought to compare the yield of testing for pre-clinical atherosclerosis with various approaches. 98 asymptomatic individuals with T2DM without known coronary artery disease (CAD) were enrolled in a prospective study and underwent carotid ultrasound, exercise treadmill testing (ETT), coronary artery calcium (CAC) scoring, and coronary computed tomography angiography (CTA). Of 98 subjects (average age 55 ± 6, 64 % female), 43 (44 %) had coronary plaque detectable on CTA, and 38 (39 %) had CAC score >0. By CTA, 16 (16 %) had coronary stenosis ≥50 %, including three subjects with CAC = 0. Subjects with coronary plaque had greater prevalence of carotid plaque (58 % vs. 38 %, p = 0.01) and greater carotid intima media thickness (0.80 ± 0.20 mm vs. 0.70 ± 0.11 mm, p = 0.02). Notably, 18 of 55 subjects (33 %) with normal CTA had carotid plaque. Eight subjects had a positive ETT, of whom five had ≥ 50 % coronary stenosis, two had <50 % stenosis, and one had no CAD. Among these tests, CAC scoring had the highest sensitivity and specificity for prediction of CAD. Among asymptomatic subjects with T2DM, a majority (56 %) had no CAD by CTA. When compared to CTA, CAC was the most accurate screening modality for detection of CAD, while ETT and carotid ultrasound were less sensitive and specific. However, 33 % of subjects with normal coronary CTA had carotid plaque, suggesting that screening for carotid plaque might better characterize stroke risk in such patients.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1475-2840 1475-2840
DOI:	10.1186/s12933-016-0334-4