Type-2 diabetes and carotid stenosis: a proposal for a screening strategy in asymptomatic patients

Abstract

Abstract:The objective of this prospective observational study was to establish the prevalence of carotid atherosclerosis in an asymptomatic diabetic population and to determine predictive factors for a screening optimization. A total of 300 consecutive type-2 diabetic subjects (166 males, 134 females) underwent a physical examination and duplex carotid scanning. Patients with a recent cerebrovascular event (Յ6 weeks) or previous carotid surgery were excluded. The prevalence of carotid stenosis Ն60% or occlusion was 4.7%; the prevalence of carotid atherosclerosis was 68.3%. Risk factors for stenosis Ն60% or occlusion were the presence of diabetic retinopathy (OR: 3.62; 95% CI: 1.12-11.73), ankle-brachial index (ABI) Ͻ0.85 (OR: 3.94; 95% CI: 1.21-12.84) and a personal history of neurological disorders (OR: 4.54; 95% CI: 1.16-17.81). Being female was a protective factor (OR: 0.09; 95% CI: 0.01-0.78). The two factors in the analysis limited to the male population were an ABI Ͻ 0.85 (OR: 3.66; 95% CI: 1.04-12.84) and a personal history of coronary heart disease (OR: 3.34; 95% CI: 1.01-11.01). If male diabetics without either of these two factors are excluded, the negative predictive value for carotid stenosis is 96.6%. In conclusion, the prevalence of atherosclerotic carotid disease in diabetic patients is high. In these patients, the probability of finding Ͼ60% stenosis is highest among men with a history of coronary heart disease or an ABI Ͻ0.85.

Carotid Artery Intima-Media Thickness, Carotid Plaque and Coronary Heart Disease and Stroke in Chinese

“…Carotid sonography has been recommended as a screening tool for future cardiovascular events among high-risk populations, such as elderly adults[17], type 2 diabetics[18] or stable CHD patients[19]. Updated consensus has proposed the standards for measurement of IMT and plaque in the carotid artery[20], [21].…”

The prognosis of diabetic patients with high ankle-brachial index depends on the coexistence of occlusive peripheral artery disease

“…17 Carotid arteries were assessed using the ACTUAL HDI 3000 (Philips Ultrasound, Bothell, Wash) ultrasound machine with a linear 7.5 MHz probe. Common or internal carotid artery plaque was defined as a focal widening of the arterial wall, relative to adjacent segments, with a luminal protrusion of more than 1.5 mm, with or without calcifications.…”

Color Doppler sonographic evaluation of flow volume of the internal carotid and vertebral arteries after carotid endarterectomy

“…The metabolic factors, carbon dioxide levels, neurogenic control, and autoregulation all appear to be involved. 30 Approximately 70-80% of this tightly controlled cerebral blood flow is carried by the carotid arteries, while the vertebral arteries supply the remaining 20-30%. Carotid disease with a severe stenosis of the ICA causes a decrease in the cerebral blood flow volume.…”