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

  • Angeladine Kenne Malaha
    Affiliations
    INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
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  • Julien Magne
    Affiliations
    INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France

    Department of Cardiology, Dupuytren University Hospital, Limoges, France
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  • Lucile Jarlan
    Affiliations
    Department of Cardiology, Dupuytren University Hospital, Limoges, France
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  • Katia Mansour
    Affiliations
    INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
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  • Melissa Ait-Ouatet
    Affiliations
    INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
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  • Sophie Galinat
    Affiliations
    Department of Endocrinology, Dupuytren University Hospital, Limoges, France
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  • Marie-Pierre Teissier
    Affiliations
    INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France

    Department of Endocrinology, Dupuytren University Hospital, Limoges, France
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  • Philippe Lacroix
    Affiliations
    INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France

    Department of Vascular Medicine & Surgery, Dupuytren University Hospital, Limoges, France
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  • Ileana Desormais
    Affiliations
    INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France

    Department of Vascular Medicine & Surgery, Dupuytren University Hospital, Limoges, France
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  • Victor Aboyans
    Correspondence
    Corresponding author at: Department of Cardiology, Dupuytren University Hospital, Limoges, France.
    Affiliations
    INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France

    Department of Cardiology, Dupuytren University Hospital, Limoges, France
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Published:April 22, 2021DOI:https://doi.org/10.1016/j.pcd.2021.04.006

      Highlights

      • Over half deaths in Type-2 diabetes patients are related to cardiovascular diseases.
      • A cardiovascular risk score merely based on clinical data has poor performance.
      • The atherosclerosis burden score is a strong determinant of cardiovascular events.
      • Screening for subclinical atherosclerosis should be implemented in the routine care.

      Abstract

      Aims

      To identify new independent vascular markers to predict cardiovascular events in patients with type-2 diabetes (T2D), and their incremental value compared to the Swedish National Diabetes Register (NDR) risk score.

      Methods

      A retrospective cohort study was conducted on 1332 asymptomatic patients with T2D, free from prior CV event, assessed for a cardiovascular work-up, including Duplex ultrasonography to detect plaque on carotid and femoral arteries. The extent of atherosclerosis was rated as atherosclerosis burden score (ABS). Patients were followed up to 5 years and the occurrence of cardiovascular events recorded.

      Results

      A total of 82 patients (6.2%) experienced a cardiovascular event, including 34 (2.6%) myocardial infarction, 18 (1.4%) cardiac revascularisation and 17 (1.3%) stroke. The independent determinants of these events were male sex (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 χ2 increase: +231%, p = 0.002).

      Conclusion

      Duplex ultrasonography to screen for atherosclerotic plaques improve the estimation of cardiovascular prognosis on top of clinical data and could be routinely used to improve cardiovascular risk stratification.

      Keywords

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