title: Ultrasound analysis of gray-scale median value of carotid plaques is a useful reference index for cerebro-cardiovascular events in patients with type 2 diabetes.
abstract: OBJECTIVE
  Measurements of plaque echogenicity, the gray-scale median (GSM), were shown to correlate inversely with risk factors for cerebro-cardiovascular disease (CVD). The eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio is a potential predictor of CVD risk. In the present study, we assessed the usefulness of carotid plaque GSM values and EPA/AA ratios in atherosclerotic diabetics.
  
  
  METHODS
  A total of 84 type 2 diabetics with carotid artery plaques were enrolled. On admission, platelet aggregation and lipid profiles, including EPA and AA, were examined. Using ultrasound, mean intima media thickness and plaque score were measured in carotid arteries. Plaque echogenicity was evaluated using computer-assisted quantification of GSM. The patients were then further observed for approximately 3 years.
  
  
  RESULTS
  Gray-scale median was found to be a good marker of CVD events. On multivariate logistic regression analysis, GSM <32 and plaque score ≥5 were significantly associated with past history and onset of CVD during the follow-up period, the odds ratios being 7.730 (P = 0.014) and 4.601 (P = 0.046), respectively. EPA/AA showed a significant correlation with GSM (P = 0.012) and high-density lipoprotein cholesterol (P = 0.039), and an inverse correlation with platelet aggregation (P = 0.046) and triglyceride (P = 0.020). Although most patients with CVD had both low GSM and low EPA/AA values, an association of EPA/AA with CVD events could not be statistically confirmed.
  
  
  CONCLUSIONS
  The present results suggest the GSM value to be useful as a reference index for CVD events in high-risk atherosclerotic diabetics. Associations of the EPA/AA ratio with known CVD risk factors warrant a larger and more extensive study to show the usefulness of this parameter.
authors.affiliation: Division of Endocrinology, Metabolism, Hematological Sciences, and Therapeutics, Department of Bio-Signal Analysis, Yamaguchi University Graduate of Medicine Ube, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Ariyoshi
authors.affiliation: Health Administration Center, Yamaguchi University Organization for University Education Yamaguchi, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Okuya
authors.affiliation: Department of Public Health, Yamaguchi University Graduate of Medicine Ube, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kunitsugu
authors.affiliation: Division of Endocrinology, Metabolism, Hematological Sciences, and Therapeutics, Department of Bio-Signal Analysis, Yamaguchi University Graduate of Medicine Ube, Japan.
authors.forename: Kimie
authors.initials: K
authors.lastname: Matsunaga
authors.affiliation: Division of Endocrinology, Metabolism, Hematological Sciences, and Therapeutics, Department of Bio-Signal Analysis, Yamaguchi University Graduate of Medicine Ube, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nagao
authors.affiliation: Division of Endocrinology, Metabolism, Hematological Sciences, and Therapeutics, Department of Bio-Signal Analysis, Yamaguchi University Graduate of Medicine Ube, Japan.
authors.forename: Ryuta
authors.initials: R
authors.lastname: Nomiyama
authors.affiliation: Division of Endocrinology, Metabolism, Hematological Sciences, and Therapeutics, Department of Bio-Signal Analysis, Yamaguchi University Graduate of Medicine Ube, Japan.
authors.forename: Komei
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Division of Endocrinology, Metabolism, Hematological Sciences, and Therapeutics, Department of Bio-Signal Analysis, Yamaguchi University Graduate of Medicine Ube, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Tanizawa
keywords: Atherosclerosis; Eicosapentaenoic acid; Plaque echogenicity