Is carotid ultrasound a useful tool in assessing cardiovascular disease in individuals with diabetes?

Coronary heart disease is a major cause of morbidity and mortality in North America. Its prevention is therefore an important clinical goal. Individuals with both Type 1 and Type 2 diabetes mellitus are at increased risk of developing heart disease as compared with those without diabetes. Carotid ultrasound is now a well-validated tool to study the presence and progression of cardiovascular disease. Using ultrasound one can determine elastic properties of the vessel wall (distensibility and compliance) as well as intima-media thickness (IMT). Several large studies have shown that IMT is a useful predictor of future cardiovascular events such as myocardial infarction and stroke, and is well correlated with other traditional risk factors such as blood pressure, lipids, level of glycemic control, and smoking. For this reason, carotid ultrasound may add valuable clinical information above and beyond that provided by traditional risk factors. The use of carotid ultrasound in the pediatric and adolescent population is increasing, and one study has shown decreased distensibility in adolescents with Type 1 diabetes mellitus versus controls. However, IMT measurements in the children and teens with Type 1 diabetes have yielded conflicting results, and larger, longitudinal studies are needed in this area.