Prognostic impact of carotid intima-media thickness and carotid plaques on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study
Prognostic impact of carotid intima-media thickness and carotid plaques on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study
复制标题
DOI：
10.1186/s12933-019-0809-1
复制
发表时间：
2019-01-10
影响因子：
9.3
通讯作者：
Salles, Gil F.
中科院分区：
文献类型：
--
作者：
Cardoso, Claudia R. L.;Salles, Guilherme C.;Salles, Gil F.
背景：颈动脉粥样硬化对糖尿病患者预后的重要性尚未确定。我们的目的是评估颈动脉粥样硬化参数与2型糖尿病患者未来微心血管并发症发生之间的关系。方法在基线时测量478名参与者的颈动脉粥样硬化、内膜-中膜厚度（CIMT）和斑块的超声参数，随访中位数为10.8年。多变量Cox分析用于检查颈动脉参数与微血管（视网膜病变、肾脏和周围神经病变）和心血管并发症（总心血管事件[CVEs]和心血管死亡率）以及全因死亡率之间的关系。采用c统计量和综合判别改善指数（IDI）评价风险分层改善情况。结果随访期间，116人发生CVE， 115人死亡（56人死于心血管疾病）；新发或加重的糖尿病视网膜病变131例，肾脏复合结局156例（新发微量白蛋白尿94例，肾功能恶化78例），新发或加重的周围神经病变83例。无论是作为连续变量还是分类变量分析，CIMT和斑块的存在预测cve的发生和肾脏结局，但不能预测死亡率或其他微血管并发症。CIMT和斑块增加的个体cve风险增加1.5- 1.8倍，肾脏结局风险增加1.6倍。与经典危险因素相比，CIMT和斑块适度改善了心血管风险的区分，idi范围为7.8 - 8.4%；但更显著地改善了对肾脏风险的辨别，idi从14.8%降至18.5%。结论颈动脉粥样硬化参数预测心血管和肾脏预后，改善肾脏危险分层。超声颈动脉成像可能有助于2型糖尿病的治疗。
BackgroundThe prognostic importance of carotid atherosclerosis in individuals with diabetes is unsettled. We aimed to evaluate the relationships between parameters of carotid atherosclerosis and the future occurrence of micro- and cardiovascular complications in individuals with type 2 diabetes.MethodsUltrasonographic parameters of carotid atherosclerosis, intima-media thickness (CIMT) and plaques, were measured at baseline in 478 participants who were followed-up for a median of 10.8years. Multivariate Cox analysis was used to examine the associations between carotid parameters and the occurrence of microvascular (retinopathy, renal, and peripheral neuropathy) and cardiovascular complications (total cardiovascular events [CVEs] and cardiovascular mortality), and all-cause mortality. The improvement in risk stratification was assessed by using the C-statistic and the integrated discrimination improvement (IDI) index.ResultsDuring follow-up, 116 individuals had a CVE and 115 individuals died (56 from cardiovascular diseases); 131 newly-developed or worsened diabetic retinopathy, 156 achieved the renal composite outcome (94 newly developed microalbuminuria and 78 deteriorated renal function), and 83 newly-developed or worsened peripheral neuropathy. CIMT, either analysed as a continuous or as a categorical variable, and presence of plaques predicted CVEs occurrence and renal outcomes, but not mortality or other microvascular complications. Individuals with an increased CIMT and plaques had a 1.5- to 1.8-fold increased risk of CVEs and a 1.6-fold higher risk of renal outcome. CIMT and plaques modestly improved cardiovascular risk discrimination over classic risk factors, with IDIs ranging from 7.8 to 8.4%; but more markedly improved renal risk discrimination, with IDIs from 14.8 to 18.5%.ConclusionsCarotid atherosclerosis parameters predicted cardiovascular and renal outcomes, and improved renal risk stratification. Ultrasonographic carotid imaging may be useful in type 2 diabetes management.