Comparison between Carotid Intima-Media Thickness and Coronary Artery Calcification in the Prediction of Atherosclerosis in Diabetic Patients

Rusli Muljadi, Bachtiar Murtala, Peter Kabo, FX Budhianto Suhadi


BACKGROUND: Cardiovascular disease is one of the atherosclerosis etiologies that can lead to death. Diabetes mellitus increases the risk of atherosclerosis. Screening tool is very beneficial for detecting atherosclerotic plaque, especially in subclinical atherosclerotic cases. Carotid intima-media thickness (CIMT) and coronary artery calcification score (CACS) are two kinds of tools that are widely used, and each of these tools has its own superiority. This study was aimed to investigate the sensitivity and specificity of both of these tools as screening tools.

METHODS: The study was conducted with a cross sectional design involving 43 diabetic and 68 non-diabetic male subjects aged above 45 years old. All subjects fulfilled inclusion criteria. Carotid artery ultrasonography and CACS measurement were performed.

RESULTS: Fischer exact test was used to show a significant correlation between CIMT and CACS (p<0.05). Diagnostic test was used to assess the sensitivity of CIMT toward CACS in above 75 percentile. The left common carotid artery (LCCA) showed the highest sensitivity either in diabetic (76.4%) or non-diabetic male subjects (90%).

CONCLUSION: CIMT has the same sensitivity with CACS. CIMT can be used as the preferred screening tool for high risk patients and as a substitution tool to CACS for low risk patients in subclinical atherosclerosis detection.

KEYWORDS: atherosclerosis, diabetes mellitus, carotid intima-media thickness, coronary artery calciication score

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Lester SJ, Eleid MF, Khandheria BK, Hurst RT. Carotid intimamedia thickness and coronary artery calcium score as indications of subclinical atherosclerosis. Mayo Clin Proc. 2009; 84: 229-33, CrossRef.

Kannel WB, McGee DL. Diabetes and cardiovascular disease. JAMA. 1979; 241: 2035-8, CrossRef.

Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998; 339: 229-34, CrossRef.

Gupta R, Joshi P, Mohan V, Reddy KS, Yusuf S. Epidemiology and causation of coronary heart disease and stroke in India. Heart. 2008; 94: 16-26, CrossRef.

Plutzky J, Viberti G, Haffner S. Atherosclerosis in type 2 diabetes mellitus and insulin resistance: mechanistic links and therapeutic targets. J Diabetes Complications. 2002; 16: 401-15, CrossRef.

Haffner SM. Abdominal adiposity and cardiometabolic risk: do we have all the answers? Am J Med. 2007; 120 (9 Suppl 1): S10-6, CrossRef.

Barnett AH. The importance of treating cardiometabolic risk factors in patients with type 2 diabetes. Diab Vasc Dis Res. 2008; 5: 9-14, CrossRef.

Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000; 20: 1262-75, CrossRef.

Takaya N, Yuan C, Chu B, Saam T, Underhill H, Cai J, et al. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI-initial results. Stroke. 2006; 37: 818-23, CrossRef.

Garcia-Garcia HM, Goedhart D, Serruys PW. Relation of plaque size to necrotic core in the three major coronary arteries in patients with acute coronary syndrome as determined by intravascular ultrasonic imaging radiofrequency. Am J Cardiol. 2007; 99: 790-2, CrossRef.

Ali YS, Rembold KE, Weaver B, Wills MB, Tatar S, Ayers CR, et al. Prediction of major adverse cardiovascular events by agenormalized carotid intimal medial thickness. Atherosclerosis. 2006; 187: 186-90, CrossRef.

Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Mosler TP, Tseng PH, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007; 49: 1860-70, PMID.

Folsom AR, Kronmal RA, Detrano RC, O'Leary DH, Bild DE, Bluemke DA, et al. Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: The Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med. 2008; 168: 1333-9, CrossRef.

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990; 15: 827-832, CrossRef.

Raggi P, Callister TQ, Cooil B, He ZX, Lippolis NJ, Russo DJ, et al. Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography. Circulation. 2000; 101: 850-5, CrossRef.

Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008; 21: 93-111, CrossRef.

Demer LL, Tintut Y. Vascular calcification: pathobiology of a multifaceted disease. Circulation 2008; 117: 2938-48, CrossRef.


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