Role of echocardiographic left ventricular mass and carotid intima-media thickness in the cardiovascular risk assessment of asymptomatic patients with type 2 diabetes mellitus.
BACKGROUND
Standard cardiovascular (CV) risk assessment may underestimate risk in people with type 2 diabetes mellitus (T2DM). Cardiac and vascular imaging to detect subclinical disease may augment risk prediction. This study investigated the association between CV risk, left ventricular hypertrophy (LVH) and carotid intima-media thickness (CIMT) in patients with T2DM free of CV symptoms.


METHODS
People with T2DM without known CV disease were recruited from general practice. The 5-year risk of CV events was calculated using an adjusted Framingham equation and the prevalence of LVH and abnormal CIMT across bands of CV risk assessed. In those at intermediate risk, the number needed to scan (NNS) to reclassify one person to high risk was calculated across the group and compared in those above and below 55 years. The association between LV mass and CIMT was also assessed.


RESULTS
Mean age 57 years (SD11), 51% female. Median 5-year CV risk 14.3% (interquartile range 10.3, 19.5), 51% had LVH (American Society of Echocardiography criteria) and 31% an abnormal CIMT (age and sex criteria). In the 52% at intermediate risk, 37% had LVH and 36% an abnormal CIMT. The NNS was 1.7 using both imaging techniques, 2.7 using cardiac imaging alone or 2.8 using vascular imaging alone. Almost twice as many people >55 years had an abnormal CIMT than those <55 years.


CONCLUSIONS
Cardiac and vascular imaging to detect subclinical disease can be used to augment prediction of CV risk in people with T2DM at intermediate risk. The value of reclassifying risk is as yet unproven and requires outcome data from intervention studies.
Poppe
K K
KK
Department of Medicine, The University of Auckland, Auckland, New Zealand. k.poppe@auckland.ac.nz
Whalley
G A
GA
Somaratne
J B
JB
Keelan
S
S
Bagg
W
W
Triggs
C M
CM
Doughty
R N
RN
D000367:Age Factors; D000368:Aged; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000473:pathology; D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000473:pathology*; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D009929:Organ Size; D018570:Risk Assessment; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000648:ultrastructure; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000648:ultrastructure