Vascular ultrasound for cardiovascular risk stratification in asymptomatic patients with type-2 diabetes

Angeladine Kenne Malaha (1, 2, 3, 4) , Julien Magne (1, 5, 6, 2, 3) , Lucile Jarlan (6) , Katia Mansour (1, 4, 2, 3) , Melissa Ait-Ouatet (1, 4, 2, 3) , Sophie Galinat (6) , Marie-Pierre Teissier (1, 6, 2, 3) , Philippe Lacroix (1, 6, 2, 3) , Ileana Desormais (1, 6, 2, 3) , Victor Aboyans (1, 6, 2, 3)

1 NET - Neuroépidémiologie Tropicale
2 GEIST - Institut Génomique, Environnement, Immunité, Santé, Thérapeutique
3 Institut d'Epidémiologie Neurologique et de Neurologie Tropicale
4 CHU Limoges
5 Service de cardiologie [CHU Limoges]
6 Hôpital Dupuytren [CHU Limoges]

AbstractAimsTo identify new independent vascular markers to predict cardiovascular events in patients with type-2 diabetes (T2D), and their incremental value compared to the Swedish National Diabetes Register (NDR) risk score.MethodsA retrospective cohort study was conducted on 1332 asymptomatic patients with T2D, free from prior CV event, assessed for a cardiovascular work-up, including Duplex ultrasonography to detect plaque on carotid and femoral arteries. The extent of atherosclerosis was rated as atherosclerosis burden score (ABS). Patients were followed up to 5 years and the occurrence of cardiovascular events recorded.ResultsA total of 82 patients (6.2%) experienced a cardiovascular event, including 34 (2.6%) myocardial infarction, 18 (1.4%) cardiac revascularisation and 17 (1.3%) stroke. The independent determinants of these events were male sex (HR = 1.81 [1.13–2.88], p = 0.013) and ABS ≥ 2 (HR = 1.98 [1.21–3.25], p = 0.007). The NDR risk score performed poorly to predict cardiovascular events (area under the curve = 0.56 [0.49–0.63], p = 0.11), whereas screening for atherosclerotic plaques provided significant incremental prognostic value over the NDR score (model χ2 increase: +231%, p = 0.002).ConclusionDuplex ultrasonography to screen for atherosclerotic plaques improve the estimation of cardiovascular prognosis on top of clinical data and could be routinely used to improve cardiovascular risk stratification.

Mots clés: Type-2 diabetes; Cardiovascular diseases; Primary prevention; Atherosclerosis burden score; Ultrasound; Plaque; Carotid; Femoral

Domaines: Santé publique et épidémiologie

Angeladine Kenne Malaha, Julien Magne, Lucile Jarlan, Katia Mansour, Melissa Ait-Ouatet, et al.. Vascular ultrasound for cardiovascular risk stratification in asymptomatic patients with type-2 diabetes. Primary Care Diabetes, 2021, ⟨10.1016/j.pcd.2021.04.006⟩. ⟨hal-03227780⟩