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Clinical implications of carotid artery intima media thickness assessment on cardiovascular risk stratification in hyperlipidemic Korean adults with diabetes: the ALTO study

Title
Clinical implications of carotid artery intima media thickness assessment on cardiovascular risk stratification in hyperlipidemic Korean adults with diabetes: the ALTO study
Author
김동선
Keywords
Subclinical atherosclerosis; Diabetes; Hyperlipidemia; Carotid artery ultrasonography
Issue Date
2015-10
Publisher
BIOMED CENTRAL LTD
Citation
BMC CARDIOVASCULAR DISORDERS, v. 15, Page. 1-8
Abstract
Background: The primary objective was to investigate prevalence of subclinical atherosclerosis in Korean individuals with diabetes and hyperlipidemia. Association of subclinical atherosclerosis with cardiovascular risk was assessed. Methods: Assessments of carotid artery intima media thickness (cIMT) and atheromatous plaque were done using B-mode ultrasonography. Subclinical atherosclerosis was diagnosed based on presence of plaque, and/or increased cIMT versus mean cIMT reference values for Korean healthy controls. Atherosclerosis risk factors were analyzed using United Kingdom Prospective Diabetes Study (UKPDS) risk engine and Framingham Risk Score. Results: In total, 355 patients were included; increased mean cIMT was observed in 15.3 % of patients, 69 % had >1 carotid artery plaque, and 72.7 % were diagnosed with subclinical atherosclerosis. In total, 60 % of subjects were taking statins, with low-density lipoprotein cholesterol level maintained similar to 80 mg/dL at enrollment. Carotid artery measures were well correlated with UKPDS and Framingham risk scores. Prevalence of subclinical atherosclerosis in the low risk group (<15 % 10-year UKPDS-predicted coronary heart disease risk) was 64.7 %; higher than predicted in previous studies. In multivariate analysis, advanced age was a significant risk factor for subclinical atherosclerosis in men and women, while increased waist circumference and longer diabetes duration were independent predictors only in women. Conclusion: Subclinical atherosclerosis is more prevalent among individuals with both diabetes and hyperlipidemia than in diabetic patients without additional cardiovascular risk factors. As conventional risk engines, based on modifiable risk factors may underestimate cardiovascular risk, early non-invasive carotid artery imaging screening may be warranted for patients with diabetes and hyperlipidemia, especially if they are elderly, have central obesity or have long duration of diabetes.
URI
https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-015-0109-yhttp://hdl.handle.net/20.500.11754/28278
ISSN
1471-2261
DOI
10.1186/s12872-015-0109-y
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