Clinical utility of carotid ultrasonography: Application for the management of patients with diabetes

Abstract

Carotid ultrasonography is a non‐invasive, simple and inexpensive modality to assess the severity of atherosclerosis. This article reviews related articles, summarizes the rationale for the application of carotid ultrasonography in clinical practice, and addresses the features and the limitations of carotid ultrasonography in cardiovascular risk prediction. Numerous large studies have confirmed that various carotid ultrasound measures, such as carotid intima‐media thickness, the presence or absence of carotid plaque, plaque number and plaque area, can be independent predictors of cardiovascular diseases in individuals with and without diabetes mellitus. Furthermore, many studies showed that the use of carotid intima‐media thickness (especially maximum intima‐media thickness, including plaque thickness) and/or carotid plaque in addition to traditional risk factors significantly improved the prediction of the occurrence of cardiovascular diseases , while controversy remains. Several studies showed that the progression of carotid intima‐media thickness also can be a surrogate end‐point of cardiovascular events. However, the accumulated evidence has not been sufficient. Further study with sufficient power should be carried out. As plaque disruption, which plays a crucial role in the pathogenesis of cardiovascular events, is dependent on the content of lipid in the atheroma and the thickness of the fibrous cap, tissue characterization of a plaque might be useful for determining its fragility. Interestingly, recent studies have shown that ultrasonic tissue characterization of carotid lesions could improve the prediction ability of future cardiovascular diseases . Thus, carotid ultrasonography is a useful modality for better clinical practice of atherosclerosis in patients with diabetes.

Vitamin K Supplementation for the Prevention of Cardiovascular Disease: Where Is the Evidence? A Systematic Review of Controlled Trials

“…Variability in the measurement of CIMT makes it difficult to compare between studies or combine results from different studies [ 31 ]. Despite these limitations, many studies have demonstrated that CIMT is associated with the presence and severity of atherosclerosis and predicts cardiovascular events, as reviewed by Katakami et al [ 32 ].…”

Carotid intima-media thickness in UK Biobank: Identification of novel genome-wide loci, sex-specific effects and genetic correlations with obesity and glucometabolic traits

“…Many studies have reported the utility of cIMT measurements as predictors of CVD (reviewed by Katakami et al 23 ), although whether predictive power is independent of traditional risk factors is still unclear. A large part of the discrepancies in the literature is likely due to the different protocols used (which part of the carotid artery is measured, whether plaque is included or not, whether mean (IMTmean) or maximum (IMTmax) values are used) in the analyses.…”

“…A large part of the discrepancies in the literature is likely due to the different protocols used (which part of the carotid artery is measured, whether plaque is included or not, whether mean (IMTmean) or maximum (IMTmax) values are used) in the analyses. Indeed it has been reported that IMTmean and IMTmax differ in their predictive value 23 . Therefore the partial overlap in loci associated with IMTmean and IMTmax is of interest.…”

Prediabetes Is Independently Associated with Subclinical Carotid Atherosclerosis: An Observational Study in a Non-Urban Mediterranean Population

“…However, apart from the qualitative assessment of the carotid plaque (i.e., present or absent), the quantitative assessment of plaque burden through the number of plaques, plaque thickness, or plaque area has rarely been assessed. This is relevant because each measure may reflect different atherosclerotic phenotypes [ 21 ].…”