Background: Cardiovascular disease is a leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Carotid-femoral pulse wave velocity (cfPWV), a reliable indicator of arterial stiffness, predicts cardiovascular events. The arterial stiffness automated measurement system (AMAS) streamlines the measurement of cfPWV, potentially increasing its clinical utility. Although carotid intima-media thickness (cIMT) is a well-established marker of subclinical atherosclerosis (AS), its predictive value for cardiovascular events in T2DM may be restricted. This study aimed to explore the application of cfPWV measured by the AMAS in cardiovascular risk assessment of patients with T2DM, aiming to provide a new clinical basis for identifying high-risk individuals with T2DM and to ascertain whether cfPWV offers superior assessment of vascular health compared to cIMT in this patient population.
Methods: This study used a cross-sectional study design. A total of 126 consecutive patients with T2DM meeting the 1999 World Health Organization (WHO) criteria for diabetes and aged 20-80 years were recruited at the Affiliated Hospital of Guangdong Medical University from February 2023 to October 2023. Continuous variables were analyzed with analysis of variance (ANOVA)/Welch's test for normal distribution and Kruskal-Wallis for non-normal data, with chi-square for counts. Regression models assessed cfPWV influences and atherosclerotic cardiovascular disease (ASCVD) risk correlation. Receiver operating characteristic (ROC) curves evaluated predictive accuracy, and intraclass correlation coefficient (ICC) assessed repeatability. The prediction for ASCVD risk in China (China-PAR) model was utilized for 10-year ASCVD risk assessment and stratification, categorizing patients into three groups: low, moderate, and high risk, with thresholds of <5%, 5-9.9%, and ≥10%, respectively. cfPWV was estimated using the ultrasonic AMAS system, and cIMT was measured using high-frequency ultrasound.
Results: The 10-year ASCVD risk among participants was 6.35% [interquartile range (IQR): 3.75-10.30%] and the cfPWV values were 8.31 (IQR, 7.13-9.87) m/s. Furthermore, the 10-year ASCVD risk tended to increase with increasing cfPWV (P<0.05), with an elevated risk of 0.875% for every 1 m/s rise in cfPWV [B =0.875, 95% confidence interval (CI): 0.596-1.155, P<0.001]. cfPWV was shown to be an independent risk factor for a high 10-year ASCVD risk [odds ratio (OR) =2.015, 95% CI: 1.399-2.902, P<0.001]. cfPWV was more effective than cIMT in predicting the 10-year ASCVD risk as high in patients with T2DM (area under the curve =0.852 vs. 0.722, P=0.038).
Conclusions: cfPWV, as measured by the ultrasonic AMAS system, exhibited efficacy in screening for patients with T2DM at elevated 10-year ASCVD risk, with its performance surpassing that of cIMT. This method holds potential in aiding clinicians to identify high-risk patients more promptly, thus enabling early intervention and enhancing personalized treatment strategies for patients.
Keywords: Carotid-femoral pulse wave velocity (cfPWV); arterial stiffness automated measurement system (arterial stiffness AMAS); atherosclerotic cardiovascular disease (ASCVD); type 2 diabetes mellitus (T2DM); ultrasound.
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