title: Type-2 diabetes and carotid stenosis: a proposal for a screening strategy in asymptomatic patients.
abstract: The objective of this prospective observational study was to establish the prevalence of carotid atherosclerosis in an asymptomatic diabetic population and to determine predictive factors for a screening optimization. A total of 300 consecutive type-2 diabetic subjects (166 males, 134 females) underwent a physical examination and duplex carotid scanning. Patients with a recent cerebrovascular event (< or = 6 weeks) or previous carotid surgery were excluded. The prevalence of carotid stenosis > or = 60% or occlusion was 4.7%; the prevalence of carotid atherosclerosis was 68.3%. Risk factors for stenosis > or = 60% or occlusion were the presence of diabetic retinopathy (OR: 3.62; 95% CI: 1.12-11.73), ankle-brachial index (ABI) <0.85 (OR: 3.94; 95% CI: 1.21-12.84) and a personal history of neurological disorders (OR: 4.54; 95% CI: 1.16-17.81). Being female was a protective factor (OR: 0.09; 95% CI: 0.01-0.78). The two factors in the analysis limited to the male population were an ABI < 0.85 (OR: 3.66; 95% CI: 1.04-12.84) and a personal history of coronary heart disease (OR: 3.34; 95% CI: 1.01-11.01). If male diabetics without either of these two factors are excluded, the negative predictive value for carotid stenosis is 96.6%. In conclusion, the prevalence of atherosclerotic carotid disease in diabetic patients is high. In these patients, the probability of finding >60% stenosis is highest among men with a history of coronary heart disease or an ABI <0.85.
authors.affiliation: Department of Cardiovascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France. philippe.lacroix@unilim.fr
authors.forename: P
authors.initials: P
authors.lastname: Lacroix
authors.forename: V
authors.initials: V
authors.lastname: Aboyans
authors.forename: M H
authors.initials: MH
authors.lastname: Criqui
authors.forename: F
authors.initials: F
authors.lastname: Bertin
authors.forename: T
authors.initials: T
authors.lastname: Bouhamed
authors.forename: F
authors.initials: F
authors.lastname: Archambeaud
authors.forename: M
authors.initials: M
authors.lastname: Laskar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply*; D001794:Blood Pressure; D001916:Brachial Artery / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D003327:Coronary Disease / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D018616:Ultrasonography, Doppler, Duplex; D014654:Vascular Patency; D014711:Vertebral Artery / Q000000981:diagnostic imaging