Risk stratification for silent coronary artery disease in patients with type-2 diabetes mellitus: Contribution of vascular duplex ultrasound

Background Coronary artery disease (CAD) is one of the main causes of death in patients with type-2 diabetes mellitus (T2DM), but is often atypical or asymptomatic. The aim of the study was to investigate the contribution of peripheral vascular ultrasound data in the risk stratification of silent CAD. Methods From 2010 to 2012, 541 patients with T2DM without cardiovascular (CV) history attended a CV screening consultation, including clinical, ECG and carotid and peripheral Duplex ultrasonography. According to findings, they were referred to a screening test for ischemic heart disease, and, if necessary, subsequent coronary angiography. Silent CAD was defined as ≥ 2 ischemic segments on stress cardiac imaging or as abnormal coronary angiography. Results Patients without chest pain and without ischemia on ECG represented 79% of the population, with a prevalence of silent CAD of 4% in this group. Medial calcinosis (MC) of crural arteries ( OR  = 5.6; 95% CI: 1.96–15.9, P  = 0.001) and the presence of ≥ 3 other CV risk factors ( OR  = 3.2; 95%CI: 1.1–9.4, P  = 0.038), were significantly associated with silent CAD. By excluding patients without any of these 2 parameters (55%), the coronary screening can be focused on a subgroup of patients at high risk (7.8%) for silent CAD, with a negative predictive value of 99.5%. Conclusion Vascular Duplex ultrasound can improve the risk stratification for silent CAD in T2DM patients.