title: Carotid plaque calcification predicts future cardiovascular events in type 2 diabetes.
abstract: OBJECTIVE
  The presence of carotid plaques is associated with future cardiovascular events, with local plaque composition being an independent outcome predictor. We examined the association between ultrasonographically determined carotid plaque calcification and incident major adverse cardiovascular events (MACE) and death in type 2 diabetes (T2D).
  
  
  METHODS
  We enrolled 581 patients with T2D who underwent routine carotid ultrasonography. Plaques were classified as echolucent (lipid rich), heterogenous, and echogenic (calcific). We collected demographic, anthropometric, and clinical data at baseline and followed the patients for up to 9 years.
  
  
  RESULTS
  Plaques were detected in 81.8% of the patients (echolucent in 16.4%, heterogenous in 43.2%, and echogenic in 22.2%). During follow-up (4.3 ± 0.1 years), 58 deaths (27 cardiovascular) and 236 fatal and nonfatal MACE occurred. In univariate analyses, presence versus absence of any carotid plaque was associated with incident MACE, and the hazard ratio (95% CI) progressively increased from echolucent (1.97 [0.93-3.44]), to heterogeneous (3.10 [2.09-4.23]), to echogenic (3.71 [2.09-5.59]) plaques. Compared with echolucent plaques, echogenic plaques were associated with incident MACE independently from confounders. This association was attenuated after adjusting for the degree of stenosis, but in patients with stenosis ≤30%, echogenic plaque type still predicted total and atherosclerotic MACE, even after further adjusting for mean intima-media thickness.
  
  
  CONCLUSIONS
  In T2D, carotid plaque calcification predicts MACE, especially in patients with a low degree of stenosis. The biology of atherosclerotic calcification in diabetes needs to be further elucidated to understand the basis of this association.
authors.affiliation: Department of Medicine, Università di Padova, Padova, Italy saula.dekreutzenberg@unipd.it.
authors.forename: Saula
authors.initials: S
authors.lastname: Vigili de Kreutzenberg
authors.affiliation: Department of Medicine, Università di Padova, Padova, Italy Venetian Institute of Molecular Medicine, Padova, Italy.
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Fadini
authors.affiliation: Venetian Institute of Oncology, Padova, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Guzzinati
authors.affiliation: Department of Medicine, Università di Padova, Padova, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Mazzucato
authors.affiliation: Diabetology Service, Montebelluna Hospital, Treviso, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Volpi
authors.affiliation: Diabetology Service, Montebelluna Hospital, Treviso, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Coracina
authors.affiliation: Department of Medicine, Università di Padova, Padova, Italy Venetian Institute of Molecular Medicine, Padova, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Avogaro
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D059168:Carotid Intima-Media Thickness / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D011446:Prospective Studies; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology*
chemical_list: D008055:Lipids