TOTAL CARDIOVASCULAR RISK ASSESSMENT AND CAROTID DAMAGE IN HYPERTENSIVE INDIVIDUALS WITH TYPE-2 DIABETES/PRE-DIABETES: A PILOT STUDY

Abstract

Objective: This study compared the performance of cardiovascular disease (CVD) risk prediction scores in terms of their association with preclinical carotid damage in patients with type-2 diabetes/pre-diabetes and hypertension without established CVD. Design and method: Adults (> = 18 years) with type-2 diabetes/pre-diabetes and hypertension, without pre-existing CVD were assessed through anthropometric parameters and blood tests. Preclinical carotid damage was assessed by echocardiographic estimation of Carotid Plaque Score (CPS). Carotid damage was defined as CPS higher than the value of the 75th percentile and/or carotid stenosis >50%. Five CVD risk scores were considered (SCORE2/OP2; FRAMINGHAM; UKPDS STR; UKPDS CHD; ASCVD). Results: Fifty-one individuals with complete data on age, sex, smoking, lipid profile and HbA1c were analyzed [mean age (years) 63.7±8.0 (SD), 63% males, body mass index (BMI) (kg/m2) 31.4±5.0 (SD), 44 diabetes, LDL-cholesterol 99.3±32.1 mg/dl, HbA1c 6.4±0.8%]. The C-statistic (ROC curve) in identifying patients with carotid damage was 0.642 [95% CI 0.487, 0.797] for SCORE2/OP2, 0.576 [95% CI 0.408, 0.745] for FRAMINGHAM, 0.696 [95% CI 0.553, 0.839] for UKPDS STR, 0.644 [95% CI 0.491, 0.796] for UKPDS CHD and 0.563 [95% CI 0.396, 0.730] for ASCVD. The UKPDS STR had a significant higher C-statistic value compared to ASCVD (p<0.05), whereas no other score discriminated better than the others in identifying individuals with preclinical carotid damage (p = NS). Conclusions: This pilot analysis suggests that the available CVD risk prediction scores show moderate ability in identifying which patients with type-2 diabetes/pre-diabetes and hypertension have preclinical carotid damage. Although there seems to be no superiority of any of them, the UKPDS STR performed somewhat better.