title: Usefulness of a systematic screening of carotid atherosclerosis in asymptomatic people with type 2 diabetes for cardiovascular risk reclassification.
abstract: OBJECTIVE
  Routine screening of carotid atherosclerosis lesions is frequently suggested for people with type 2 diabetes, the presence of a carotid lesion being associated with a significant increase risk for vascular events. However, the impact of this strategy on medical management is not validated. We herein question the usefulness of such screening.
  
  
  METHODS
  We assessed the prevalence and severity of carotid lesions in 337 consecutive people with type 2 diabetes without known cardiovascular disease who underwent a systematic carotid duplex ultrasonography. We analyzed whether the results of duplex ultrasonography allowed reclassification of cardiovascular risk level relative to the most recent international recommendations on diabetes and modified therapy.
  
  
  RESULTS
  We found that 35.9% of people had no atherosclerotic lesion. Prevalence of carotid stenosis<20%, between 20 and 50% and ≥50% were 32.9%, 28.4% and 2.7% respectively. Regarding the use of statins and LDL-C target, the result of carotid duplex ultrasonography allowed to reclassify respectively 11.8% to 55.2% of the cohort in a higher cardiovascular risk level. For the indication of antiplatelet agent, reclassification in a higher risk level concerned 6.8% of the patients. No subject had an indication of carotid revascularization.
  
  
  CONCLUSIONS
  Carotid atherosclerosis is frequent in asymptomatic people with type 2 diabetes in primary cardiovascular prevention. Screening for carotid atherosclerosis by duplex ultrasonography seems useful to redefine the level of cardiovascular risk.
authors.affiliation: Department of vascular medecine, hospices civils de Lyon, centre hospitalier Lyon-Sud, Pierre-Bénite, France.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Helfre
authors.affiliation: Department of vascular medecine, hospices civils de Lyon, centre hospitalier Lyon-Sud, Pierre-Bénite, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Grange
authors.affiliation: Department of biostatistics, hospices civil de Lyon, 69310 Lyon, France; Universite Lyon I, Villeurbanne, France; CNRS, UMR 5558, laboratoire biostatistiques Santé, 69310 Pierre-Bénite, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Riche
authors.affiliation: Department of biostatistics, hospices civil de Lyon, 69310 Lyon, France; Universite Lyon I, Villeurbanne, France; CNRS, UMR 5558, laboratoire biostatistiques Santé, 69310 Pierre-Bénite, France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Maucort-Boulch
authors.affiliation: Department of endocrinology, diabetes and nutrition, pavillon médical, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France; Inserm U1060, faculté de médecine Lyon sud, chemin du Grand-Revoyet, Oullins, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Thivolet
authors.affiliation: Department of endocrinology, diabetes and nutrition, pavillon médical, hospices civils de Lyon, centre hospitalier Lyon-Sud, 69310 Pierre-Bénite, France. Electronic address: julien.vouillarmet@chu-lyon.fr.
authors.forename: Julien
authors.initials: J
authors.lastname: Vouillarmet
mesh_terms: D000328:Adult; D000368:Aged; D058070:Asymptomatic Diseases; D002318:Cardiovascular Diseases / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D002340:Carotid Artery Diseases / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000175:diagnosis* / Q000453:epidemiology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D018616:Ultrasonography, Doppler, Duplex
keywords: Athérome carotidien; Cardiovascular prevention; Carotid atherosclerosis; Carotid duplex ultrasonography; Diabète de type 2; Prévention cardiovasculaire; Type 2 diabetes; Écho-doppler