Role of echocardiographic left ventricular mass and carotid intima-media thickness in the cardiovascular risk assessment of asymptomatic patients with type 2 diabetes mellitus
Poppe, K.K.; Whalley, Gillian; Somaratne, Jithendra B.; Keelan, S.; Bagg, Warwick; Triggs, C. M.; Doughty, Robert N.
Date
2011Citation:
Poppe, K. K., Whalley, G. A., Somaratne, J. B., Keelan, S., Bagg, W., Triggs, C. M., & Doughty, R. N. (2011). Role of echocardiographic left ventricular mass and carotid intima‐media thickness in the cardiovascular risk assessment of asymptomatic patients with type 2 diabetes mellitus. Internal Medicine Journal, 41(5), 391-398.Permanent link to Research Bank record:
https://hdl.handle.net/10652/2129Abstract
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.