Carotid ultrasonography: A potent tool for better clinical practice in diagnosis of atherosclerosis in diabetic patients

Cardiovascular disease (CVD) remains the main cause of death in diabetic patients, and once it has developed, diabetic patients have a worse outcome as compared with non-diabetic patients. One reason for this is the difficulty of early diagnosis of atherosclerotic change in these patients. Although cardiovascular risk assessment based on conventional risk factors is recommended for predicting cardiovascular risk, validation studies showed only moderate performance. In contrast, it is unrealistic to screen for subclinical or silent atherosclerosis by sophisticated modalities, such as myocardial perfusion scintigraphy, coronary computed tomography angiography or conventional angiography in all diabetic patients, as these tests are limited by the potential of significant adverse effects, technical difficulty, availability and high cost. Therefore, a non-invasive and inexpensive tool for risk prediction of subclinical atherosclerosis is required for identifying individuals at high risk of CVD. Recently, a number of studies have shown close associations between carotid atherosclerosis and cerebrovascular or coronary artery disease. Carotid ultrasonography has allowed clinicians to visualize the characteristics of the carotid wall and lumen surfaces to quantify the severity of atherosclerosis. Carotid intima-media thickness (IMT) is an especially useful marker of the progression of atherosclerosis throughout the body, and is an excellent predictor of cardiovascular events. As a simple and non-invasive procedure, measurement of carotid IMT is one of the most appropriate screening methods to specify high-risk individuals in subjects with and without diabetes. Therefore, it is expected that carotid ultrasonography will become a potent tool for better clinical practice of atherosclerosis in diabetic patients.