Diabetes Metab J.  2018 Aug;42(4):285-295. 10.4093/dmj.2017.0080.

Cardio-Ankle Vascular Index as a Surrogate Marker of Early Atherosclerotic Cardiovascular Disease in Koreans with Type 2 Diabetes Mellitus

• Park SY
• Chin SO
• Rhee SY
• Oh S
• Woo JT
• Kim SW
• Chon S

• KMID: 2418717
• DOI: http://doi.org/10.4093/dmj.2017.0080

Abstract

BACKGROUND
Carotid artery intima medial thickness (IMT), brachial-ankle pulse wave velocity (baPWV), and ankle-brachial index (ABI) are commonly used surrogate markers of subclinical atherosclerosis in patients with type 2 diabetes mellitus (T2DM). The cardio-ankle vascular index (CAVI) is a complement to the baPWV, which is affected by blood pressure. However, it is unclear which marker is the most sensitive predictor of atherosclerotic cardiovascular disease (ASCVD).
METHODS
This was a retrospective non-interventional study that enrolled 219 patients with T2DM. The correlations among IMT, ABI, and CAVI as well as the relationship of these tests to the 10-year ASCVD risk were also analyzed.
RESULTS
Among the 219 patients, 39 (17.8%) had ASCVD. In the non-ASCVD group, CAVI correlated significantly with IMT after adjusting for confounding variables, but ABI was not associated with CAVI or IMT. The analyses after dividing the non-ASCVD group into three subgroups according to the CAVI score ( < 8, ≥8 and < 9, and ≥9) demonstrated the significant increase in the mean IMT, 10-year ASCVD risk and number of metabolic syndrome risk factors, and decrease in the mean ABI in the high-CAVI group. A high CAVI was an independent risk factor in the non-ASCVD group for both a high 10-year ASCVD risk (≥7.5%; odds ratio [OR], 2.42; P < 0.001) and atherosclerosis (mean IMT ≥1 mm; OR, 1.53; P=0.007).
CONCLUSION
In Korean patients with T2DM without ASCVD, CAVI was the most sensitive of several surrogate markers for the detection of subclinical atherosclerosis.

Keyword

Atherosclerosis; Cardiovascular diseases; Diabetes mellitus, type 2; Korea

MeSH Terms

Ankle Brachial Index
Atherosclerosis
Biomarkers*
Blood Pressure
Cardiovascular Diseases*
Carotid Arteries
Complement System Proteins
Confounding Factors (Epidemiology)
Diabetes Mellitus, Type 2*
Humans
Korea
Odds Ratio
Pulse Wave Analysis
Retrospective Studies
Risk Factors
Biomarkers
Complement System Proteins

Figure

• 

  Fig. 1 The utility of cardio-ankle vascular index (CAVI), ankle-brachial index (ABI), mean intima medial thickness (IMT), and maximal IMT for predicting the prevalence of atherosclerotic cardiovascular disease (ASCVD) in all subjects (A), and 10-year ASCVD risk scores in subjects without ASCVD (B). CA, carotid artery.

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