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

BackgroundWe 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.MethodsOver 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).ResultsWe enrolled 517 consecutive asymptomatic patients (63% male, mean age 6410years; 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.ConclusionsIn 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.