Journal of Cardiovascular Nursing Vol. 31, No. 2, pp E1YE7 x Copyright B 2016 Wolters Kluwer Health, Inc. All rights reserved. Subclinical Carotid Atherosclerosis in Asymptomatic Subjects With Type 2 Diabetes Mellitus Esther Rubinat, RN, MSc; Josep Ramon Marsal, Stat; Teresa Vidal, RN; Cristina Cebrian, RN; Mireia Falguera, MD; Ma. Belen Vilanova, MD; A ` ngels Betriu, MD, PhD; Elvira Ferna ´ ndez, MD, PhD; Josep Franch, MD, PhD; Dı ´dac Mauricio, MD, PhD Background: Subjects with type 2 diabetes mellitus are considered to be at high risk for cardiovascular disease. The identification of carotid atherosclerosis is a validated surrogate marker of cardiovascular disease. Nurses are key professionals in the improvement and intensification of cardiovascular preventive strategies. Aims: The aim is to study the presence of carotid atherosclerosis in a group of asymptomatic subjects with type 2 diabetes mellitus and no previous clinical cardiovascular disease. Methods: A total of 187 patients with type 2 diabetes mellitus and 187 age- and sex-matched subjects without type 2 diabetes mellitus were studied in this cross-sectional, observational, cohort study. Standard operational procedures were applied by the nursing team regarding physical examination and carotid ultrasound assessment. Common, bulb, and internal carotid arteries were explored by measuring intima-media thickness and identifying atherosclerotic plaques. Results: Carotid intima-media thickness (c-IMT) and carotid plaque prevalence were significantly greater in diabetic subjects than in the control group. Carotid plaques and c-IMT were more frequent in men than in women and increased with increasing age. In the multivariate analysis, age, gender, waist circumference, systolic blood pressure, and hypercholesterolemia were positively associated with c-IMT, whereas age, gender, and weight were positively associated with carotid plaque. Conclusion: The current nurse-led study shows that subjects with type 2 diabetes mellitus have a high prevalence of subclinical atherosclerosis that is associated with cardiovascular risk factors. KEY WORDS: atherosclerotic plaque, cardiovascular diseases, carotid intima-media thickness primary prevention, type 2 diabetes mellitus Esther Rubinat, RN, MSc Research Nurse, PhD Student, Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova; and Institut de Recerca Biom6dica de Lleida, University of Lleida, Spain. Josep Ramon Marsal, Stat Statistician, Unitat de Suport a la Recerca de Lleida, Institut Universitari d’Investigacio ´ en Atencio ´ Prima `ria Jordi Gol (IDIA Jordi Gol), Lleida; and Unitat de Epidemiologia, Servicio de Cardiologı ´a, Hospital Universitari Vall d’Hebron, Barcelona, Spain. Teresa Vidal, RN Nurse, Unitat de Deteccio ´ i Tractament de Malalties Aterotrombo ` tiques, Hospital Universitari Arnau de Vilanova; and Department of Nephrology, Hospital Universitari Arnau de Vilanova, Lleida, Spain. Cristina Cebrian, RN Nurse, Primary Health Care Center Primer de Maig, Lleida, Spain. Mireia Falguera, MD General Practitioner, Primary Health Care Center Igualada Nord, Spain. Ma. Belen Vilanova, MD General Practitioner, Primary Health Care Center Igualada Nord, Spain. A ` ngels Betriu, MD, PhD Coordinator, Unitat de Deteccio ´ i Tractament de Malalties Aterotrombo ` tiques, Hospital Universitari Arnau de Vilanova; and Department of Nephrology, Hospital Universitari Arnau de Vilanova, Lleida, Spain. Elvira Ferna ´ ndez, MD, PhD Head of Department and Associate Professor, Unitat de Deteccio ´i Tractament de Malalties Aterotrombo ` tiques, Hospital Universitari E1 Arnau de Vilanova; and Department of Nephrology, Hospital Universitari Arnau de Vilanova, Lleida, Spain. Josep Franch, MD, PhD General Practitioner, Primary Health Care Center Raval Sud; and Institut Universitari d’Investigacio ´ en Atencio ´ Prima `ria Jordi Gol, Barcelona, Spain. Dı ´dac Mauricio, MD, PhD Chief Physician, Unitat de Deteccio ´ i Tractament de Malalties Aterotrombo ` tiques, Hospital Universitari Arnau de Vilanova, Lleida; Institut Universitari d’Investigacio ´ en Atencio ´ Prima ` ria Jordi Gol, Barcelona; and Department of Endocrinology and Nutrition, Hospital Germans Trias Pujol, Badalona, Spain. This study was funded in part by grants nos. PS09/01035 and PI12/00183 from Instituto de Salud Carlos III, Ministry of Economy and Competitiveness, Spain. Both included in Plan Nacional de I+D+I and co-financed by Instituto de Salud Carlos III - Subdireccion General de Evaluacio ´ n and Fondo Europeo de Desarrollo Regional (FEDER). The authors have no conflicts of interest to disclose. Correspondence Esther Rubinat, MSc, RN, Servicio de Endocrinologia y Nutricio ´ n, Hospital Universitari Arnau de Vilanova, Avda Rovira Roure 80, 25198 Lleida, Spain (erubinat.irblleida@gmail.com) or Dı ´dac Mauricio, MD, PhD, Department of Endocrinology & Nutrition, Hospital Germans Trias Pujol, Carretera Can Ruti S/N, 08916, Badalona, Spain (didacmauricio@gmail.com). DOI: 10.1097/JCN.0000000000000236 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.