Qualitative score of systemic arteriosclerosis by vascular ultrasonography as a predictor of coronary artery disease in type 2 diabetes
Introduction
Patients with type 2 diabetes (T2DM) are at a substantially higher risk of mortality, primarily from cardiovascular disease, than the general population [1]. They can also develop severe polyvascular complications, such as atherosclerosis, cerebrovascular disease (CVD), coronary artery disease (CAD), nephrosclerosis, abdominal aneurysm and peripheral arterial disease (PAD) [2], [3], with a poor prognosis. In this regard, the currently available non-invasive methods do not allow accurate early assessment of systemic arteriosclerosis.
Myocardial ischemia in T2DM patients is often asymptomatic [4] and frequently in an advanced stage when it manifests clinically. Furthermore, diabetics are often at higher risk of new-onset and recurrence of myocardial infarction compared with non-diabetics [5]. The morbidity and mortality of CAD patients with T2DM are also worse than in non-diabetics [5]. Therefore, non-invasive and early prediction of CAD is important in T2DM to prevent cardiovascular events. Previous studies reported that carotid intima-media thickness (IMT) measured by ultrasonography correlates with CAD and cardiovascular events [6], [7]. Although measurement of IMT is a non-invasive and useful method for screening CAD, the cut off values of carotid IMT for identification of CAD are controversial [6], [7].
The aim of the present study was to determine the relation between CAD and systemic arteriosclerosis estimated by qualitative vascular ultrasonography. Specifically, we assessed the utility of the total systemic vascular score, as a non-invasive qualitative index of systemic arteriosclerosis measured by vascular ultrasonography, in the prediction of CAD in T2DM patients.
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Participants
The study subjects were 102 consecutive Japanese patients with T2DM who visited the outpatient clinic of the Department of Metabolic Medicine, Osaka University Hospital, between September 2009 and March 2011, and subsequently underwent evaluation for systemic arteriosclerosis by ultrasonography. Table 1 summarizes the profiles of all participants. The Medical Ethics Committee of Osaka University approved this study. All participants were Japanese and each gave a written informed consent. This
Characteristics of diabetic patients
The baseline characteristics of the 102 patients with T2DM are listed in Table 1. The mean age was 67 ± 9 years (range 40–85 years). In the present study, 71% of the patients (n = 73/102) had visceral fat accumulation (estimated visceral fat area; eVFA ≥ 100 cm2), based on the Japanese criteria of visceral fat accumulation measured by CT scan [19] and by the bioelectrical impedance analysis method [20], 61% (n = 62/102) had the metabolic syndrome, and 53% (n = 54/102) of patients had CAD.
Evaluation of systemic arteriosclerosis
Fig. 2A shows the
Discussion
The major findings of the present study were: (1) more than 60% of type 2 DM Japanese patients had systemic arteriosclerosis (average duration of diabetes mellitus was 12.8 years), (2) systemic vascular score ≥2 was a significant marker for CAD, and (3) the performance of total systemic vascular score of ≥2 for the diagnosis of CAD was better than the mean and max IMT.
Patients with symptomatic atherothrombosis including those with T2DM have polyvascular diseases (coronary artery disease,
Conflict of interest
The authors declare no conflict of interest.
Funding
This research was supported in part by a Grant-in-Aid for Scientific Research on Innovative Areas No. 22126008 (to T.F. and K.K.)
Contributions
A.H and K.K. recruited the patients, collected and analyzed the data, and wrote the manuscript. K.K. also participated in the concept and design of the study, interpretation of data and reviewed/edited the manuscript. A.H-S. and H.N. recruited and examined the patients, and collected data. T.F. and I.S. contributed to the discussion and wrote the manuscript. All authors read and approved the final version of the manuscript.
Acknowledgements
We are grateful to Dr. Norikazu Maeda for patient enrolment, and Dr. Hiroshi Mastuo, Mrs. Kayoko Asahi and Mr. Tomohiro Kitazawa for help with ultrasonography. We also thank all staff at “Diabetes & Metabolic Station” for the excellent medical care.
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