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

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 x2 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. (c) 2021 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

Automated summary

The study aimed to identify new independent vascular markers to predict cardiovascular events in patients with T2D, with male sex and ABS >= 2 being identified as independent determinants of these events. Screening for atherosclerotic plaques provided significant incremental prognostic value over the NDR score in predicting cardiovascular events.