Vascular ultrasound for cardiovascular risk stratification in asymptomatic patients with type-2 diabetes

Abstract

Cardiovascular diseases are among the main long-term complications of type-2 diabetes (T2D). Several tools have been proposed to estimate the cardiovascular (CV) risk in patients with T2D, but their prognostic value requires further investigation. We aimed to identify new independent vascular markers to predict CV events in patients with T2D, and their incremental value compared to the Swedish National Diabetes Register (NDR) risk score. A retrospective cohort study was conducted on 1332 asymptomatic patients with T2D, free from prior CV event, assessed for CV work-up, including 12-lead ECG, ankle-brachial index and carotid and femoral bifurcations ultrasound to detect plaque in any of the 4 territories (right and left carotid and femoral arteries). The extent of atherosclerosis was rated from 0 to 4 and recorded as atherosclerosis burden score (ABS). Patients were followed up to 5 years and the occurrence of CV events (cardiovascular death, stroke/transient ischemic attack, myocardial infarction, unstable angina and cardiac revascularisation) was recorded. A total of 82 patients (6.2%) experienced a cardiovascular event, including 34 (2.6%) with myocardial infarction, 18 (1.4%) with cardiac revascularisation and 17 (1.3%) with stroke. The independent determinants of these events were: male gender (HR = 1.81 [1.13–2.88], P = 0.013) and ABS ≥ 2 (HR = 1.98 [1.21–3.25], P = 0.007). The NDR risk score performed poorly to predict cardiovascular events (area under the curve = 0.56 [0.49–0.63], P = 0.11), whereas screening for atherosclerotic plaques provided significant incremental prognostic value over the NDR score (model χ 2 increase: +231%, P = 0.002). Duplex ultrasonography for atherosclerotic plaques improve the estimation of CV prognosis on top of clinical data. Because of its high availability and safety, it could be routinely used to stratify the cardiovascular risk and implement the guidelines-based interventions.