Prognostic implications of surrogate markers of atherosclerosis in low to intermediate risk patients with Type 2 Diabetes

Abstract

BackgroundType 2 diabetes mellitus (T2DM) patients are at increased risk of developing cardiovascular events. Unfortunately traditional risk assessment scores, including the Framingham Risk Score (FRS), have only modest accuracy in cardiovascular risk prediction in these patients.MethodsWe sought to determine the prognostic values of different non-invasive markers of atherosclerosis, including brachial artery endothelial function, carotid artery atheroma burden, ankle-brachial index, arterial stiffness and computed tomography coronary artery calcium score (CACS) in 151 T2DM Chinese patients that were identified low-intermediate risk from the FRS recalibrated for Chinese (<20% risk in 10 years). Patients were prospectively followed-up and presence of atherosclerotic events documented for a mean duration of 61 ± 16 months.ResultsA total of 17 atherosclerotic events in 16 patients (11%) occurred during the follow-up period. The mean FRS of the study population was 5.0 ± 4.6% and area under curve (AUC) from receiver operating characteristic curve analysis for prediction of atherosclerotic events was 0.59 ± 0.07 (P = 0.21). Among different vascular assessments, CACS > 40 had the best prognostic value (AUC 0.81 ± 0.06, P < 0.01) and offered significantly better accuracy in prediction compared with FRS (P = 0.038 for AUC comparisons). Combination of FRS with CACS or other surrogate vascular markers did not further improve the prognostic values over CACS alone. Multivariate Cox regression analysis identified CACS > 40 as an independent predictor of atherosclerotic events in T2DM patients (Hazards Ratio 27.11, 95% Confidence Interval 3.36-218.81, P = 0.002).ConclusionsIn T2DM patients identified as low-intermediate risk by the FRS, a raised CACS > 40 was an independent predictor for atherosclerotic events.

Prognostic impact of the ankle–brachial index on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro Type 2 Diabetes Cohort Study

“…As a whole, our findings support the recommendation that the ABI should be more widely used in the routine clinical management of individuals with type 2 diabetes, not only in those with signs or symptoms suggesting PAD, as currently recommended. Some previous longitudinal studies in individuals with type 2 diabetes [20][21][22][23][24][25][26][27][28] and in individuals with and without diabetes [14][15][16][17] have reported that the ABI is a risk marker for future CVE occurrence and mortality, whereas other studies have contradicted this finding [11-13, 18, 19]. Our findings corroborate the studies reporting positive results.…”

“…Indeed, some previous studies have demonstrated a lack of prognostic value for the ABI in diabetic individuals in contrast to non-diabetic individuals [11][12][13], although others have reported similar positive predictive performances in diabetic and non-diabetic individuals [14][15][16][17]. Similarly, conflicting results regarding the prognostic value of the ABI have been reported by cohort studies comprised exclusively of individuals with type 2 diabetes, with some studies negating [18,19] and others demonstrating [20][21][22][23][24][25][26][27][28] its importance. Moreover, some of the positive studies [24,25,27,28] assessed whether the ABI, beyond being a risk marker, was also capable of improving risk stratification for adverse outcomes, with contradictory findings.…”

“…Similarly, conflicting results regarding the prognostic value of the ABI have been reported by cohort studies comprised exclusively of individuals with type 2 diabetes, with some studies negating [18,19] and others demonstrating [20][21][22][23][24][25][26][27][28] its importance. Moreover, some of the positive studies [24,25,27,28] assessed whether the ABI, beyond being a risk marker, was also capable of improving risk stratification for adverse outcomes, with contradictory findings. This is a fundamental step before more widespread use of the ABI in the clinical management of type 2 diabetes can be recommended.…”

Evaluation of carotid artery elasticity changes in patients with type 2 diabetes

“…Secondly, although some clinical measurements were different between two groups’ comparisons in the present study, no obvious relationship was found with the arterial stiffness changes by the statistical correlation analysis, further analyze the data with adjustment was not performed as other studies did [28,29]. Thirdly, considering the fact that the number of subjects with the presence of plaque was not sufficient for quantitative statistical analysis, the value of plaque score [30] was not evaluated in this study.…”

Potential of Monocyte Count for the Assessment of Cardiovascular Disease

“…The leukocyte count has been reported to correlate with coronary heart disease (CHD) since 1920s [2]. In addition, many epidemiologic studies have reported that an increased leukocyte count is a strong and independent risk factor for cardiovascular events [3][4][5][6][7][8][9][10] and for the prevalence and progression of subclinical carotid atherosclerosis [11][12][13][14][15][16], suggesting that leukocyte count is useful as a clinical marker to predict atherosclerotic diseases. On the other hand, leukocyte count includes several types of cells which have different participation form in atherogenesis.…”