Prognostic implications of surrogate markers of atherosclerosis in low to intermediate risk patients with Type 2 Diabetes (original) (raw)
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Journal of Internal Medicine, 2015
Background-There is a need to develop and validated surrogate markers of cardiovascular disease (CVD) in diabetes. The macrovascular changes associated with diabetes include an aggravated atherosclerosis, increased arterial stiffness and endothelial dysfunction. In the present study we aimed to determine which of these factors are most effective at identifying patients who have a clinically manifest cardiovascular event. Methods and results-We measured carotid intima media thickness (IMT), ankle-brachial pressure index (ABPI), pulse wave velocity (PWV) and endothelial function assessed by the reactive hyperemia index (RHI) in a cohort of 458 subjects with type 2 diabetes (T2D) and CVD (myocardial infarction, stroke or lower extremity arterial disease), 527 subjects with T2D but no clinically manifest CVD and 515 non-T2D subjects with or without CVD. Carotid IMT and ABPI demonstrated independent association with the presence of clinical CVD in T2D, while assessment of PWV and RHI provide limited independent additive information. Measurement of IMT in the bulb provided a better discrimination of the presence of CVD in T2D than measurement of IMT in the common carotid artery. The most important factors associated with increased carotid IMT in T2D were age, diabetes duration, systolic blood pressure, impaired renal function and increased arterial stiffness, whereas no or only weak independent associations were found with metabolic factors and endothelial dysfunction. Conclusions-Our findings demonstrate that measures of atherosclerotic burden show the best association with clinically manifest CVD in T2D. They also show that vascular changes not directly related to known metabolic risk factors are of importance in atherosclerosis and CVD in T2D. A better understanding of these mechanisms will be of critical importance for development of more effective preventive cardiovascular therapies in diabetes.
Clinical cardiology, 2018
We sought to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in an asymptomatic population. Over a 6-year period, 10-year Framingham risk score together with carotid ultrasound and coronary computed tomography angiography were evaluated for prediction of major adverse cardiac events (MACE). We enrolled 517 consecutive asymptomatic patients (63% male, mean age 64 ±10 years; 17.6% with diabetes). Median (interquartile range) coronary artery calcium score (CACS) was 34 (0-100). Over a median follow-up of 4.4 (3.4-5.1) years, there were 53 MACE (10%). Patients experiencing MACE had higher CACS, incidence of carotid disease, presence of CAD ≥50%, and remodeled plaque as compared with patients without MACE. At multivariable analyses, presence of CAD ≥50% (HR: 5.14, 95% CI: 2.1-12.4) and percentage of segments with remodeled plaque (HR: 1.04, 95% CI: 1.03-1.06) independently pred...
Diabetes care, 2018
Cardiovascular disease (CVD) risk prediction represents an increasing clinical challenge in the treatment of diabetes. We used a panel of vascular imaging, functional assessments, and biomarkers reflecting different disease mechanisms to identify clinically useful markers of risk for cardiovascular (CV) events in subjects with type 2 diabetes (T2D) with or without manifest CVD. The study cohort consisted of 936 subjects with T2D recruited at four European centers. Carotid intima-media thickness and plaque area, ankle-brachial pressure index, arterial stiffness, endothelial function, and circulating biomarkers were analyzed at baseline, and CV events were monitored during a 3-year follow-up period. The CV event rate in subjects with T2D was higher in those with ( = 440) than in those without ( = 496) manifest CVD at baseline (5.53 vs. 2.15/100 life-years, < 0.0001). New CV events in subjects with T2D with manifest CVD were associated with higher baseline levels of inflammatory bio...
Nutrition, metabolism, and cardiovascular diseases : NMCD, 2008
The aims of this study were to establish the prevalence of metabolic syndrome (MS), in type 2 diabetes mellitus (DM), according to National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria, and to assess the association of MS with other cardiovascular (CV) risk factors in these patients. A cross-sectional study was conducted in 1610 patients with type 2 DM. Glycated hemoglobin A1c (HbA1c), total cholesterol, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), uric acid, fibrinogen, creatinine, and albumin/creatinine ratios were measured. The risk of coronary heart disease (CHD) was calculated using the UKPDS Risk Engine. Seventy percent of the diabetic population met the criteria for MS; central obesity and hypertension were the most common criteria. Subjects with MS had higher levels of HbA1c, LDL-C, non-HDL-C, uric acid, and fibrinogen compared to patients without MS. Similarly, microalbuminuria and a high tr...
Archives of Endocrinology and Metabolism, 2017
Objectives: Cardiovascular risk estimated by several scores in patients with diabetes mellitus without a cardiovascular disease history and the association with carotid atherosclerotic plaque (CAP) were the aims of this study. Materials and methods: Cardiovascular risk was calculate using United Kingdom Prospective Diabetes Study (UKPDS) risk engine, Framingham risk score for cardiovascular (FSCV) and coronary disease (FSCD), and the new score (NS) proposed by the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol. Ultrasound was used to assess CAP occurrence. A receiver operating characteristic (ROC) analysis was performed. Results: One hundred seventy patients (mean age 61.4 ± 11 years, 58.8% men) were included. Average FSCV, FSCD and NS values were 33.6% ± 21%, 20.6% ± 12% and 24.8% ± 18%, respectively. According to the UKPDS score, average risk of coronary disease and stroke were 22.1% ± 16% and 14.3% ± 19% respectively. Comparing the risks estimated by the different scores a significant correlation was found. The prevalence of CAP was 51%, in patients with the higher scores this prevalence was increased. ROC analysis showed a good discrimination power between subjects with or without CAP. Conclusion: The cardiovascular risk estimated was high but heterogenic. The prevalence of CAP increased according to the strata of risk. Understanding the relationship between CAP and scores could improve the risk estimation in subjects with diabetes.
Development and Validation of a Total Coronary Heart Disease Risk Score in Type 2 Diabetes Mellitus
The American Journal of Cardiology, 2008
There are no validated risk scores for predicting coronary heart disease (CHD) in Chinese patients with type 2 diabetes mellitus. This study aimed to validate the UKPDS risk engine and, if indicated, develop CHD risk scores. A total of 7,067 patients without CHD at baseline were analyzed. Data were randomly assigned to a training data set and a test data set. Cox models were used to develop risk scores to predict total CHD in the training data set. Calibration was assessed using the Hosmer-Lemeshow test, and discrimination was examined using the area under the receiver-operating characteristic curve in the test data set. During a median follow-up of 5.40 years, 4.97% of patients (n ؍ 351) developed incident CHD. The UKPDS CHD risk engine overestimated the risk of CHD with suboptimal discrimination, and a new total CHD risk score was developed. The developed total CHD risk score was 0.0267 ؋ age years) ؊ 0.3536 ؋ sex (1 if female) ؉ 0.4373 ؋ current smoking status (1 if yes) ؉ 0.0403 ؋ duration of diabetes (years) ؊ 0.4808 ؋ Log 10 (estimated glomerular filtration rate [ml/min/1.73 m 2 ]) ؉ 0.1232 ؋ Log 10 (1 ؉ spot urinary albumin-creatinine ratio [mg/mmol]) ؉ 0.2644 ؋ non-high-density lipoprotein cholesterol (mmol/L). The 5-year probability of CHD ؍ 1 ؊ 0.9616 EXP(0.9440 ؋ [RISK SCORE ؊ 0.7082]) .
ASSESSMENT OF CARDIOVASCULAR RISK INDICES IN TYPE 2 DIABETES MELLITUS
Background: Dyslipidemia a common feature of diabetes mellitus leads to cardiovascular complications. These complications are not detected early enough due to absence of cheap and routine biomarker. Aim: Therefore, the aim of this study is to assess the cardiovascular risk indices of diabetes mellitus individuals using Atherogenic coefficient (Ac), Cardiac Risk Ratio (CRR), Atherogenic index of plasma (AIP) and Non- HDL – cholesterol (surrogate marker for apolipoprotein B) in this locality. Methods: Serum Total Cholesterol (TC), Triglycerides (TG), High Density Lipoprotein Cholesterol (HDL-C), Low Density Lipoprotein-Cholesterol (LDL-C), Very Low Density Lipoprotein-Cholesterol (VLDL-C) as well as cardiovascular risk indices (Cardiac Risk Ratio (CRR), atherogenic coefficient (Ac), atherogenic index of plasma (AIP) and Non-HDL cholesterol) were assessed. Results: The TC,TG,LDL-C,VLDL-C as well as all the cardiometabolic risk indices of diabetes were observed to be significantly high (P<0.05) when compared with control subjects. HDL-C in diabetes was observed to be significantly low (P<0.05) when compared with control subjects. Conclusion: The results indicates greater propensity of diabetes to cardiovascular complications. We therefore advocate routine use of these indices as part of lipid profile in order to nip any cardiovascular complication early enough.
Atherosclerosis, 2012
Objective: Undiagnosed diabetes (DM2), especially in individuals that have experienced a major atherosclerotic vascular event, could increase the risk of a second major cardiovascular (CV) event. The aim of this study was to evaluate the impact of type 2 diabetes (DM2), diagnosed after a major cardiovascular event, on subsequent CV disease in high risk individuals. Methods: 411 subjects without known DM2 and with a history of a prior major CV event were followed for a second major CV event (fatal and nonfatal MI, fatal and nonfatal stroke or any arterial revascularization procedure). At baseline, each individual underwent a physical, biochemical examination, an OGTT and dosed A1c. In addition, patients were classified as having monovascular or polyvascular disease. The average follow-up duration was 31 months. Results: The incidence of second CV events was 10.70 per 100 person-years (114 events/1066 personyears). The diagnosis of occult DM2 was not associated with major CV events, either using A1c values !6.5%, fasting glucose !126 mg/dL or 2 h post-load glucose !200 mg/dL. Polyvascular disease was the only significant predictor of a second major CV event (HR 2.60, 95% CI 1.72e3.95) after adjustment for age, BMI, smoking status, systolic blood pressure, high-density and low-density lipoprotein cholesterol and high sensitivity C-reactive protein.
Metabolism, 2003
Atherosclerotic vascular diseases are frequently associated with diabetes mellitus. There has been increasing evidence showing that the atherosclerotic diseases in diabetic patients are distinct from diabetic microvascular complications as to their pathophysiology and epidemiology. However, we have no information on the prevalence of asymptomatic atherosclerosis in diabetic patients before the onset of microvascular diseases. In the present investigation, we aimed to evaluate risk factors for the atherosclerosis in type 2 diabetic patients without the microvascular diseases. For this purpose, we evaluated atherosclerotic change of carotid arteries in 125 Japanese type 2 diabetic patients who had neither atherosclerotic vascular diseases nor diabetic microvascular complications. When atherosclerotic change was defined as the mean intima-media thickness (IMT) of > 1.1 mm and/or the presence of plaque lesion, 50% of patients had atherosclerosis of the carotid arteries. Risk factors for the carotid atherosclerosis were age, low-density lipoprotein (LDL)-cholesterol, hypertension, and diabetes treatment. Age and LDL-cholesterol were associated with mean IMT. Age, diabetes treatment, LDL-cholesterol, and hypertension were positively associated with plaque lesion, while high-density lipoprotein (HDL)-cholesterol was negatively associated with it. Fasting plasma glucose, glycosylated hemoglobin (HbA 1c), and known diabetes duration remained unassociated with any parameters of asymptomatic atherosclerosis of the carotid arteries. These results indicate that glycemic control is unrelated with asymptomatic atherosclerosis in type 2 diabetic patients without diabetic microvascular complications. Conventional risk factors and diabetes treatment are independently associated with atherosclerosis of the carotid arteries in these patients.