Does the addition of carotid ultrasonography measures to conventional risk factors improve the prediction of cardiovascular events in patients with diabetes without apparent CVD?
The addition of carotid ultrasonography measures, such as IMT and plaque echolucency, to conventional risk factors significantly improves cardiovascular risk stratification in diabetic patients without prior CVD.
AIM: It remains unclear whether measures used in carotid ultrasonography such as the intima-media thickness (IMT) and ultrasonic tissue characterization of the carotid using the gray-scale median (GSM) can add prognostic information beyond the conventional cardiovascular risk markers in patients with diabetes. METHODS: This study employed a combined analysis of data obtained in five longitudinal studies including a total of 3263 patients with diabetes but without apparent cardiovascular disease (CVD) at baseline. The associations between carotid ultrasonography measures and the first occurrence of CVD (488 cases), which were defined as cardiovascular death, coronary artery diseases, stroke, or peripheral artery disease, were analyzed. RESULTS: Common carotid artery (CCA)-mean-IMT, CCA-max-IMT, Max-IMT, plaque-GSM, and the presence of low-GSM echolucent plaques at baseline were prognostic factors for CVD even after adjustment for conventional risk factors. Time-dependent receiver-operating-characteristic (ROC) curve analysis indicated that the use of CCA-mean-IMT, CCA-max-IMT, and Max-IMT in addition to the conventional risk factors improved significantly the prediction of occurrence of CVD. Increments in the CCA-mean-IMT (hazard ratio HR 2.37 for every 0.1-mm/year increment 95% confidence interval [CI: 1.63-3.47], p＜0.001), Max-IMT (HR 1.51 for every 0.1-mm/year increment 95% CI: 1.07-2.14, p=0.020), and Mean-GSM (HR 0.22 for every 10-U/year increment 95% CI: 0.06-0.76, p=0.016) during the observation period were also prognostic factors for CVD even after adjusting for the baseline value of the respective measure. CONCLUSIONS: Addition of carotid ultrasonography measures to conventional risk factors significantly improved the stratification of patients by cardiovascular risk. Changes over time in carotid ultrasonography measures may be used as therapeutic outcome measures.
Katakami et al. (2018) studied this question.