Naoto Katakami1,2, Tomoya Mita3,4, Masahiko Gosho5, Mitsuyoshi Takahara1,6, Yoko Irie7, Tetsuyuki Yasuda7, Taka-Aki Matsuoka1, Takeshi Osonoi8, Hirotaka Watada3,4,9, Iichiro Shimomura1. 1. Department of Metabolic Medicine, Osaka University Graduate School of Medicine. 2. Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine. 3. Department of Metabolism & Endocrinology, Juntendo University Graduate School of Medicine. 4. Center for Molecular Diabetology, Juntendo University Graduate School of Medicine. 5. Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba. 6. Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine. 7. Osaka Police Hospital. 8. Nakakinen Clinic. 9. Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine.
Abstract
AIM: It remains unclear whether measures used in carotid ultrasonography such as the intima-media thickness (IMT) and ultrasonic tissue characterization of the carotid using the gray-scale median (GSM) can add prognostic information beyond the conventional cardiovascular risk markers in patients with diabetes. METHODS: This study employed a combined analysis of data obtained in five longitudinal studies including a total of 3263 patients with diabetes but without apparent cardiovascular disease (CVD) at baseline. The associations between carotid ultrasonography measures and the first occurrence of CVD (488 cases), which were defined as cardiovascular death, coronary artery diseases, stroke, or peripheral artery disease, were analyzed. RESULTS: Common carotid artery (CCA)-mean-IMT, CCA-max-IMT, Max-IMT, plaque-GSM, and the presence of low-GSM echolucent plaques at baseline were prognostic factors for CVD even after adjustment for conventional risk factors. Time-dependent receiver-operating-characteristic (ROC) curve analysis indicated that the use of CCA-mean-IMT, CCA-max-IMT, and Max-IMT in addition to the conventional risk factors improved significantly the prediction of occurrence of CVD. Increments in the CCA-mean-IMT (hazard ratio [HR] 2.37 for every 0.1-mm/year increment [95% confidence interval [CI]: 1.63-3.47], p＜0.001), Max-IMT (HR 1.51 for every 0.1-mm/year increment [95% CI: 1.07-2.14], p=0.020), and Mean-GSM (HR 0.22 for every 10-U/year increment [95% CI: 0.06-0.76], p=0.016) during the observation period were also prognostic factors for CVD even after adjusting for the baseline value of the respective measure. CONCLUSIONS: Addition of carotid ultrasonography measures to conventional risk factors significantly improved the stratification of patients by cardiovascular risk. Changes over time in carotid ultrasonography measures may be used as therapeutic outcome measures.
AIM: It remains unclear whether measures used in carotid ultrasonography such as the intima-media thickness (IMT) and ultrasonic tissue characterization of the carotid using the gray-scale median (GSM) can add prognostic information beyond the conventional cardiovascular risk markers in patients with diabetes. METHODS: This study employed a combined analysis of data obtained in five longitudinal studies including a total of 3263 patients with diabetes but without apparent cardiovascular disease (CVD) at baseline. The associations between carotid ultrasonography measures and the first occurrence of CVD (488 cases), which were defined as cardiovascular death, coronary artery diseases, stroke, or peripheral artery disease, were analyzed. RESULTS: Common carotid artery (CCA)-mean-IMT, CCA-max-IMT, Max-IMT, plaque-GSM, and the presence of low-GSM echolucent plaques at baseline were prognostic factors for CVD even after adjustment for conventional risk factors. Time-dependent receiver-operating-characteristic (ROC) curve analysis indicated that the use of CCA-mean-IMT, CCA-max-IMT, and Max-IMT in addition to the conventional risk factors improved significantly the prediction of occurrence of CVD. Increments in the CCA-mean-IMT (hazard ratio [HR] 2.37 for every 0.1-mm/year increment [95% confidence interval [CI]: 1.63-3.47], p＜0.001), Max-IMT (HR 1.51 for every 0.1-mm/year increment [95% CI: 1.07-2.14], p=0.020), and Mean-GSM (HR 0.22 for every 10-U/year increment [95% CI: 0.06-0.76], p=0.016) during the observation period were also prognostic factors for CVD even after adjusting for the baseline value of the respective measure. CONCLUSIONS: Addition of carotid ultrasonography measures to conventional risk factors significantly improved the stratification of patients by cardiovascular risk. Changes over time in carotid ultrasonography measures may be used as therapeutic outcome measures.
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