Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population

A.I. Guaricci, V. Lorenzoni, M. Guglielmo, S. Mushtaq, G. Muscogiuri, F. Cademartiri, M. Rabbat, D. Andreini, G. Serviddio, N. Gaibazzi, M. Pepi, G. Pontone

Research output: Contribution to journalArticlepeer-review


Background: We sought to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in an asymptomatic population. Methods: Over a 6-year period, 10-year Framingham risk score together with carotid ultrasound and coronary computed tomography angiography were evaluated for prediction of major adverse cardiac events (MACE). Results: We enrolled 517 consecutive asymptomatic patients (63% male, mean age 64 ±10 years; 17.6% with diabetes). Median (interquartile range) coronary artery calcium score (CACS) was 34 (0–100). Over a median follow-up of 4.4 (3.4–5.1) years, there were 53 MACE (10%). Patients experiencing MACE had higher CACS, incidence of carotid disease, presence of CAD ≥50%, and remodeled plaque as compared with patients without MACE. At multivariable analyses, presence of CAD ≥50% (HR: 5.14, 95% CI: 2.1–12.4) and percentage of segments with remodeled plaque (HR: 1.04, 95% CI: 1.03–1.06) independently predicted MACE (P <0.001). Models adding CAD ≥50% or percentage of segments with remodeled plaque resulted in higher discrimination and reclassification ability compared with a model based on 10-year FRS, carotid disease, and CACS. Specifically, the C-statistic improved to 0.75 with addition of CAD and 0.84 when adding percentage of segments with remodeled plaque, whereas net reclassification improvement indices were 0.86 and 0.92, respectively. Conclusions: In an asymptomatic population, CAD and plaque positive remodeling increase MACE prediction compared with a model based on 10-year FRS, carotid disease, and CACS estimation. In the diabetes subgroup, percentage of segments with remodeled plaque was the only predictor of MACE. © 2018 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)769-777
Number of pages9
JournalClinical Cardiology
Issue number6
Publication statusPublished - 2018


  • Calcium Scoring
  • Cardiovascular Prevention
  • Carotid Disease
  • Computed Tomography
  • Coronary Artery Disease
  • Diabetes Mellitus
  • Subclinical Atherosclerosis
  • adult
  • Article
  • carotid atherosclerosis
  • clinical evaluation
  • computed tomographic angiography
  • controlled study
  • coronary artery atherosclerosis
  • coronary artery calcium score
  • diabetes mellitus
  • female
  • follow up
  • Framingham risk score
  • human
  • incidence
  • intravascular ultrasound
  • major adverse cardiac event
  • major clinical study
  • male
  • prognostic assessment
  • retrospective study
  • vascular remodeling
  • aged
  • arterial wall thickness
  • asymptomatic disease
  • atherosclerotic plaque
  • blood vessel calcification
  • carotid artery disease
  • chi square distribution
  • coronary angiography
  • coronary artery disease
  • diagnostic imaging
  • Italy
  • middle aged
  • multidetector computed tomography
  • multivariate analysis
  • procedures
  • prognosis
  • proportional hazards model
  • risk factor
  • time factor
  • Aged
  • Asymptomatic Diseases
  • Carotid Artery Diseases
  • Carotid Intima-Media Thickness
  • Chi-Square Distribution
  • Computed Tomography Angiography
  • Coronary Angiography
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Multivariate Analysis
  • Plaque, Atherosclerotic
  • Prognosis
  • Proportional Hazards Models
  • Risk Factors
  • Time Factors
  • Vascular Calcification

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