Incremental Predictive Value of Carotid Ultrasonography in the Assessment of Coronary Risk in a Cohort of Asymptomatic Type 2 Diabetic Subjects

• Published in: Diabetes care Vol. 28; no. 5; pp. 1158 - 1162
• Main Authors: Bernard, Sophie, Sérusclat, André, Targe, François, Charrière, Sybil, Roth, Olivier, Beaune, Jacques, Berthezène, François, Moulin, Philippe
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-05-2005
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular diseases; Carotid artery; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - epidemiology; Coronary Artery Disease - epidemiology; Coronary heart disease; Coronary vessels; Diabetes; Diabetes Mellitus, Type 2 - epidemiology; Diabetes. Impaired glucose tolerance; Diagnosis; Disease-Free Survival; electrocardiography; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; exercise; Exercise Test; Female; Follow-Up Studies; guidelines; Health risk assessment; Heart; Humans; Logistic Models; Male; Medical examination; Medical sciences; Middle Aged; myocardial ischemia; noninsulin-dependent diabetes mellitus; patients; prediction; Predictive Value of Tests; Prevention; Prospective Studies; risk; Risk Factors; screening; Tunica Intima - diagnostic imaging; Tunica Media - diagnostic imaging; Ultrasonic imaging; Ultrasonography; Ultrasound imaging; United States; Endocrinopathy; Sonography; Type 2 diabetes; Human; Cardiovascular disease; Metabolic diseases; Asymptomatic; Coronary heart disease; Artery; Blood vessel; Carotid; Cohort study; Echography; Risk factor; Predictive value; Circulatory system; Public health
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.28.5.1158

OBJECTIVE: --Consensus guidelines recommend cardiovascular risk assessment as the initial step of primary prevention. The aim of this study was to evaluate the incremental predictive value for coronary events conferred by carotid ultrasonography in addition to risk assessment by Framingham score and screening for silent myocardial ischemia in a cohort of type 2 diabetic patients. RESEARCH DESIGN AND METHODS --We prospectively studied 229 patients free of any cardiovascular complication with at least one additional cardiovascular risk factor. At baseline, all patients had an exercise treadmill test, carotid intima-media thickness (IMT) measurement, and coronary risk assessment by Framingham score. Cardiovascular events were registered during a 5-year follow-up period. RESULTS: --Age, carotid IMT, carotid plaques, number of risk factors, Framingham score, and suboptimal exercise electrocardiogram were associated with incident cardiovascular events (P < 0.05). Carotid IMT was an independent predictor of cardiovascular events (P = 0.045). The predictive value for coronary events was similar for carotid IMT and Framingham score as assessed by area under the receiver operating characteristic curves. An improvement in risk prediction was conferred by addition of carotid IMT in a Cox model (global [chi]² increased from 14.1 to 18.1, P = 0.035). CONCLUSIONS: --This prospective study confirms that carotid IMT is a marker of cardiovascular risk in this type 2 diabetic cohort, establishes that carotid IMT provides a similar predictive value for coronary events than Framingham score, and suggests that the combination of these two indexes significantly improves risk prediction for these patients.