Improvement of cardiovascular risk assessment in Type 2 diabetes by the addition of carotid artery intima–media thickness to Framingham risk score: A retrospective cohort study

BACKGROUND: The intima-media thickness (IMT) of the carotid artery is highly correlated with cardiovascular events in Type 2 diabetes mellitus (T2DM). The aim of the present study was to undertake a cardiovascular risk assessment in a group of patients (n = 102) who had been followed-up for 10 years. METHODS: Framingham risk score (FRS), IMT, and various other clinical parameters were evaluated retrospectively using Student's t-test, regression analysis, and χ² tests. Primary endpoints were defined as cardiovascular death, non-fatal myocardial infarction, angina, and ischemic stroke. RESULTS: The IMT (1.09 ± 0.32 vs 0.89 ± 0.25; P < 0.001) and percentage coronary risk as determined by the FRS (24.33 ± 11.07 vs 16.54 ± 8.35; P = 0.001) were significantly higher in patients presenting with any of the primary endpoints compared with patients in whom no cardiovascular morbidity or mortality was recorded. Other factors that significantly predicted cardiovascular mortality and morbidity included diastolic blood pressure and urinary albumin excretion (UAE; P < 0.001). The likelihood of primary endpoints could be predicted by UAE >30 mg/day, carotid artery IMT ≥0.9 mm, and FRS ≥20 (odds ratios 8.800, 3.377, and 2.807, respectively). CONCLUSION: Although FRS predicts 10-year risk for cardiovascular mortality and morbidity in T2DM, we suggest that UAE and carotid artery IMT should also be considered in risk assessments.