Abstract
Background and Aims European recommendations on cardiovascular prevention suggest that carotid atherosclerosis assessment by duplex ultrasonography could help in some cases to better assess CV risk. We investigated whether the presence of carotid atherosclerosis determined by duplex ultrasonography is associated with cardiovascular events in patients with type 2 diabetes and could therefore help to reclassify cardiovascular risk. Methods Among 624 consecutive patients with type 2 diabetes and carotid atherosclerosis assessment by duplex ultrasonography between January and December 2012, 583 (93%) were included and followed up prospectively. The primary endpoint was the occurrence of cardiovascular events. The rate of new cardiovascular events was compared between patients with (n = 104) and those without (n = 479) prior cardiovascular events. Results A total of new 104 cardiovascular events occurred in 72 patients (12.5%) during a mean ± SD follow-up period of 5.1 ± 1.6 years. At baseline, for 202 patients (34.6%), carotid evaluation was normal; 381 (65.4%) had a carotid atherosclerosis lesion. The presence of carotid atherosclerosis at baseline was not significantly associated with an increased risk of new cardiovascular events in both groups. The rate of new cardiovascular events was more than twice as high in patients with prior cardiovascular event than those without. Conclusion Systematic carotid atherosclerosis assessment by duplex ultrasonography in patients with type 2 diabetes and a contemporary cardiovascular prevention treatment does not offer additional information as to the risk of cardiovascular events. This trial is registered with ClinicalTrials.gov (ID: NCT02929355).
Highlights
There has been notable improvement in the management of patients with type 2 diabetes and the decrease of cardiovascular (CV) events over recent years [1], patients with diabetes are still considered at a high risk of vascular events by the latest international guidelines on CV prevention [2, 3]
The mean ± standard deviation (SD) duration of which was 5:1 ± 1:6 years, and the median was 5.7 (0.2-7.6) years; there was no significant difference in baseline characteristics between patients with or without follow-up
A total of 104/583 patients (18%) had a prior CV event, and among those without a prior CV event, 313/479 patients (65%) had an estimated risk of CV event at 10 years greater than 10% according to the American Diabetes Association (ADA) [3] and 160/479
Summary
There has been notable improvement in the management of patients with type 2 diabetes and the decrease of cardiovascular (CV) events over recent years [1], patients with diabetes are still considered at a high risk of vascular events by the latest international guidelines on CV prevention [2, 3]. We investigated whether the presence of carotid atherosclerosis determined by duplex ultrasonography is associated with cardiovascular events in patients with type 2 diabetes and could help to reclassify cardiovascular risk. Among 624 consecutive patients with type 2 diabetes and carotid atherosclerosis assessment by duplex ultrasonography between January and December 2012, 583 (93%) were included and followed up prospectively. Systematic carotid atherosclerosis assessment by duplex ultrasonography in patients with type 2 diabetes and a contemporary cardiovascular prevention treatment does not offer additional information as to the risk of cardiovascular events. This trial is registered with ClinicalTrials.gov (ID: NCT02929355)
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