Carotid ultrasound investigation as a prognostic tool for patients with diabetes mellitus

Abstract

Background Experimental and clinical data indicate a major influence of diabetes on atherogenesis. We aimed to assess whether the effect of diabetes on long-term mortality in asymptomatic patient with carotid stenosis is contingent upon the degree of the carotid atherosclerotic burden. Methods 1065 patients with neurological asymptomatic carotid atherosclerosis as evaluated by duplex sonography were prospectively followed for cause-specific mortality. Results During a median of 11.8 years, a total of 549 deaths, including 362 cardiovascular deaths, were recorded. Diabetes and glycohemoglobin A1c (Hba1c) levels were significantly associated with mortality. Diabetes displayed an independent risk for all-cause (adjusted HR 1.62; 95% CI 1.35–1.94) and cardiovascular death (adjusted HR 1.75, 95% CI 1.40–2.19). The adjusted hazard ratio per increase of 1% of Hba1c levels was 1.21 (P < 0.01) for all-cause and 1.31 (P < 0.01) for cardiovascular mortality, respectively. Patients with diabetes mellitus and a higher degree of carotid stenosis and were at great risk of adverse outcome. Only 21% of the asymptomatic diabetic patients with carotid narrowing over 50% survived, whereas 62% of the patients without diabetes and with carotid atherosclerosis below 50% were still alive after 12-years of follow-up. The high risk for all-cause and cardiovascular death of these patients remained significant after adjustment for various established cardiovascular risk factors in multivariable regression analysis (adjusted hazard ratio 2.4, P < 0.001; compared to patients without diabetes and < 50% carotid atherosclerosis). Conclusion Diabetic patients with carotid stenosis ≥ 50% are at exceptional high risk for all-cause and cardiovascular death. Thus, routinely ultrasound investigation of the carotid arteries might be a valuable prognostic tool for patients with diabetes mellitus.

Diabetes and carotid artery disease: a narrative review

“…Similar findings were observed in another study involving 1,065 patients with neurological asymptomatic carotid atherosclerosis (median follow up: 11.8 years) (7). DM was diagnosed in 335 (31.5%) of the participants; most had T2DM (95.3%).…”

“…DM was diagnosed in 335 (31.5%) of the participants; most had T2DM (95.3%). In this study, the adjusted hazard ratio (HR) for every 1% increase in glycated haemoglobin (HbA 1c ) levels was 1.31 (P<0.01) for cardiovascular (CV) mortality and 1.21 (P<0.01) for all-cause mortality, respectively (7).…”

Associations of continuous glucose monitoring-assessed glucose variability with intima-media thickness and ultrasonic tissue characteristics of the carotid arteries: a cross-sectional analysis in patients with type 2 diabetes

“…Carotid ultrasonography is one of the assessment procedures for atherosclerosis and has several advantages, such as noninvasiveness, simplicity, inexpensiveness, and reproducibility. Moreover, it was reported that it could be a prognostic tool for patients with diabetes [ 6 ]. Due to these advantages, the indices of carotid ultrasonography have been used as a marker of atherosclerosis in previous clinical studies [ 7 – 15 ].…”

Prognostic Value of Cardiovascular Testing in Asymptomatic Patients With a History of Cardiovascular Disease: A Review of Contemporary Medical Literature

“…The thickening of intima-media determined via carotid duplex also facilitates CVD prognostication in asymptomatic scenarios. There is now an advocation to use the results of a carotid duplex in anticipating long-term mortality in neurologically asymptomatic diabetic patients with CVD/carotid arteriosclerosis [23]. This is because the results obtained from carotid duplex screening have a high validity and reliability making it a preferred diagnostic modality for evaluating the risk and prognosis of atherosclerosis in the setting of CVD [24].…”