Prognostic implications of surrogate markers of atherosclerosis in low to intermediate risk patients with Type 2 Diabetes

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• 作者：Kui-Kai Lau (1) (2)
  Yuen-Kwun Wong (1)
  Yap-Hang Chan (3)
  Kai-Hang Yiu (2) (4)
  Kay-Cheong Teo (1)
  Leonard Sheung-Wai Li (5)
  Shu-Leong Ho (1) (2)
  Koon-Ho Chan (1) (2)
  Chung-Wah Siu (2) (4)
  Hung-Fat Tse (2) (4)
  
• 关键词：Vascular markers of atherosclerosis ; Type 2 diabetes mellitus
• 刊名：Cardiovascular Diabetology
• 出版年：2012
• 出版时间：December 2012
• 年：2012
• 卷：11
• 期：1
• 全文大小：219KB
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• 作者单位：Kui-Kai Lau (1) (2)
  Yuen-Kwun Wong (1)
  Yap-Hang Chan (3)
  Kai-Hang Yiu (2) (4)
  Kay-Cheong Teo (1)
  Leonard Sheung-Wai Li (5)
  Shu-Leong Ho (1) (2)
  Koon-Ho Chan (1) (2)
  Chung-Wah Siu (2) (4)
  Hung-Fat Tse (2) (4)
  
  1. Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
  2. Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
  3. School of Public Health, The University of Hong Kong, Hong Kong SAR, China
  4. Division of Cardiology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
  5. Division of Rehabilitation Medicine, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong SAR, China
  

文摘

Background Type 2 diabetes mellitus (T2DM) patients are at increased risk of developing cardiovascular events. Unfortunately traditional risk assessment scores, including the Framingham Risk Score (FRS), have only modest accuracy in cardiovascular risk prediction in these patients. Methods We sought to determine the prognostic values of different non-invasive markers of atherosclerosis, including brachial artery endothelial function, carotid artery atheroma burden, ankle-brachial index, arterial stiffness and computed tomography coronary artery calcium score (CACS) in 151 T2DM Chinese patients that were identified low-intermediate risk from the FRS recalibrated for Chinese (<20% risk in 10?years). Patients were prospectively followed-up and presence of atherosclerotic events documented for a mean duration of 61?±-6?months. Results A total of 17 atherosclerotic events in 16 patients (11%) occurred during the follow-up period. The mean FRS of the study population was 5.0?±-.6% and area under curve (AUC) from receiver operating characteristic curve analysis for prediction of atherosclerotic events was 0.59?±-.07 (P--.21). Among different vascular assessments, CACS-gt;-0 had the best prognostic value (AUC 0.81?±-.06, P-lt;-.01) and offered significantly better accuracy in prediction compared with FRS (P--.038 for AUC comparisons). Combination of FRS with CACS or other surrogate vascular markers did not further improve the prognostic values over CACS alone. Multivariate Cox regression analysis identified CACS-gt;-0 as an independent predictor of atherosclerotic events in T2DM patients (Hazards Ratio 27.11, 95% Confidence Interval 3.36-218.81, P--.002). Conclusions In T2DM patients identified as low-intermediate risk by the FRS, a raised CACS-gt;-0 was an independent predictor for atherosclerotic events.