Atherosclerosis 221 (2012) 438–444 Contents lists available at SciVerse ScienceDirect Atherosclerosis journa l h omepa g e: www.elsevier.com/locate/atherosclerosis Maximum carotid intima-media thickness improves the prediction ability of coronary artery stenosis in type 2 diabetic patients without history of coronary artery disease Yoko Irie a , Naoto Katakami a,b , Hideaki Kaneto a,∗ , Ryuichi Kasami a , Satoru Sumitsuji c , Keita Yamasaki c , Kouichi Tachibana c , Tadashi Kuroda c , Ken’ya Sakamoto d , Yutaka Umayahara e , Yasunori Ueda d , Keisuke Kosugi d , Iichiro Shimomura a a Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan b Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, Osaka, Japan c Department of Advanced Cardiovascular Therapeutics/Cardiology, Osaka University Graduate School of Medicine, Osaka, Japan d Osaka Police Hospital, Osaka, Japan e Osaka General Medical Center, Osaka, Japan a r t i c l e i n f o Article history: Received 27 September 2011 Received in revised form 26 December 2011 Accepted 10 January 2012 Available online 21 January 2012 Keywords: Diabetes IMT Obesity Coronary artery disease a b s t r a c t Objective: Carotid intima-media thickness (CIMT), a marker of early atherosclerosis and vascular remod- elling, is one of the independent predictors of coronary artery disease (CAD). However, it is unknown whether ultrasonic assessment of carotid atherosclerosis, including CIMT, improves the prediction ability for CAD over and above conventional coronary risk factors in the diabetic patients. Methods: Ultrasonic scanning of the common carotid artery (CCA), the carotid bulb (Bul), and the internal carotid artery (ICA) was performed. The site with the greatest IMT, including plaque lesions, was sought along the arterial walls and max-IMT (the greatest IMT in the observation-possible areas of the CCA, Bul and ICA) was measured. The association of max-IMT with coronary artery stenosis assessed by coronary computed tomography angiography and the incremental effect of adding max-IMT to the conventional risk factors for predicting coronary artery stenosis were evaluated in 241 asymptomatic type 2 diabetic patients. Results: Multiple logistic regression analyses showed that max-IMT was significantly associated with coronary artery stenosis even after adjustment for conventional risk factors. ROC curve analysis revealed that the AUC significantly increased after addition of max-IMT to conventional coronary risk factors [from 0.64 (95% CI; 0.57–0.71) to 0.74 (95% CI; 0.67–0.80), p = 0.020]. The addition of max-IMT to conventional coronary risk factors increased the AUC in obese patients (from 0.58 to 0.76, p = 0.012) but not in non-obese patients (from 0.68 to 0.72, NS). Conclusions: In type 2 diabetic patients without apparent cardiovascular disease, the addition of max-IMT to conventional risk factors substantially improves the risk stratification for CAD. © 2012 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Since coronary artery disease (CAD) is a major cause of death and impairment of quality of life [1–4] in patients with type 2 diabetes mellitus (T2DM), its early detection and rapid interven- tion is critical in the management of these patients. However, especially in patients with T2DM, CAD generally is detected at an advanced stage, whereas an asymptomatic stage is often missed [5–7]. In addition, cardiovascular risk assessment based on ∗ Corresponding author. Tel.: +81 6 6879 3743; fax: +81 6 6879 3739. E-mail address: kaneto@endmet.med.osaka-u.ac.jp (H. Kaneto). conventional risk factors does not fully explain the distribution of risk [8,9], since conventional coronary risk factors do not directly reflect structural and functional changes in arteries caused by atherosclerosis that is closely associated with CAD. Carotid intima- media thickness (CIMT), a marker of early atherosclerosis and vascular remodelling that can be assessed quickly, non-invasively, and cheaply with high-resolution ultrasound, is correlated with conventional coronary risk factors and regarded as a surrogate marker of atherosclerosis. Previous studies have established CIMT as one of the most reliable markers for systemic atherosclerosis, and many studies have shown that carotid CIMT is associated with cardiovascular events and CAD [10–13]. These findings suggest that it is possible that measurement of CIMT is useful for early 0021-9150/$ – see front matter © 2012 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.atherosclerosis.2012.01.022