Health  Vol.5 No.7 A , July 2013
Discrimination and stratification tests of cardiovascular disease risk assessment models against ultrasound detection of carotid plaques in type 2 diabetics

Atherosclerosis is the early stage of arterial disease, and underlies development of cardiovascular disease (CVD) and stroke. Although sophisticated models for assessing CVD and stroke risk have been derived based on large-scale prospective studies, their abilities in detecting the presence or absence of atherosclerotic plaque have not been investigated. This study aimed to evaluate and compare discriminatory and risk stratifying abilities of 13 CVD risk assessment models against the ultrasound detection of carotid plaques in type 2 diabetes mellitus (T2DM) patients. Forty-nine T2DM subjects were recruited with informed consent, and major anthropomorphic and biomarker data for these models were collected. The model risk scores were evaluated against the carotid plaques detected by Doppler ultrasound. Only the FHS-Lpts-CHD-10Y model, which is a variant of the Framingham model, revealed an area under the receiver operating curve (AUROC) that was significantly different from a random scoring approach (AUROC: 0.681, p < 0.05), and was able to stratify the risk levels of carotid plaque presence (Chi-Square statistic: 5.99, p < 0.05).

Cite this paper: C. Chan, L. , Sun, Y. and Benzie, I. (2013) Discrimination and stratification tests of cardiovascular disease risk assessment models against ultrasound detection of carotid plaques in type 2 diabetics. Health, 5, 1-10. doi: 10.4236/health.2013.57A1001.

[1]   Dzau, V.J., Braun-Dullaeus, R.C. and Sedding, D.G. (2002) Vascular proliferation and atherosclerosis: New perspectives and therapeutic strategies. Nature Medicine, 8, 1249-1256. doi:10.1038/nm1102-1249

[2]   Goldschmidt-Clermont, P.J., Creager, M.A., Lorsordo, D.W., Lam, G.K.W., Wassef, M. and Dzau, V.J. (2005) Atherosclerosis 2005—Recent discovery and novel hypotheses. Circulation, 112, 3348-3353. doi:10.1161/CIRCULATIONAHA.105.577460

[3]   Lloyd-Jones, D., Adams, R., Carnethon, M., Simone, G.E., Ferguson, T.B., Flegal, K., et al. (2009) Heart disease and stroke statistics 2009 update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation, 119, e21-e181. doi:10.1161/CIRCULATIONAHA.108.191261

[4]   Wyman, R.A., Mays, M.E., McBride, P.E. and Stein, J.H. (2006) Ultrasound-detected carotid plaque as a predictor of cardiovascular events. Vascular Medicine, 11, 123-130. doi:10.1191/1358863x06vm666ra

[5]   D’Agostino, R. B., Grundy, S., Sullivan, L.M., Wilson, P., et al. (2001) Validation of the framingham coronary heart disease prediction scores: Results of a multiple ethnic groups investigation. The Journal of the American Medical Association, 286, 180-187. doi:10.1001/jama.286.2.180

[6]   Chambless, L.E., Heiss, G., Shahar, E., Earp, M.J. and Toole, J. (2004) Prediction of ischemic stroke risk in the atherosclerosis risk in communities study. American Journal of Epidemiology, 160, 259-269. doi:10.1093/aje/kwh189

[7]   Stevens, R.J., Kothari, V., Adler, A.I., Stratton, I.M., Holman, R.R. on Behalf of the United Kingdom Prospective Diabetes Study (UKPDS) Group (2001) The UKPDS risk engine: A model for the risk of coronary heart disease in type II diabetes (UKPDS 56). Clinical Science (Lond), 101, 671-679. doi:10.1042/CS20000335

[8]   Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). The Journal of the American Medical Association, 285, 2486-2497. doi:10.1001/jama.285.19.2486

[9]   Eckel, R.H., Kahn, R., Robertson, R.M. and Rizza, R.A. (2006) Preventing cardiovascular disease and diabetes: A call to action from the american diabetes association and the american heart association. Circulation, 113, 2943-2946. doi:10.1161/CIRCULATIONAHA.106.176583

[10]   Liu, J., Hong, Y.L. and D’Agostino, R.B. (2004) Predictive value for the chinese population of the framingham CHD risk assessment tool compared with the chinese multi-provincial cohort study. The Journal of the American Medical Association, 291, 2591-2599. doi:10.1001/jama.291.21.2591

[11]   The Hong Kong Diabetes Registry (2007) Development and validation of stroke risk equation for Hong Kong Chinese patients with type 2 diabetes. Diabetes Care, 30, 65-70. doi:10.2337/dc06-1273

[12]   Chia, Y.C. (2011) Review of tools of cardiovascular disease risk stratification: Interpretation, customization and application in clinical practice. Singapore Medical Journal, 52, 116-123.

[13]   Wu, Y., Liu, X., Li, X., Li, Y., Zhao, L., Chen, Z., et al. (2006) Estimation of 10-year risk of fatal and nonfatal ischemic cardiovascular diseases in Chinese adults. Circulation, 114, 2217-2225. doi:10.1161/CIRCULATIONAHA.105.607499

[14]   Chan, L. and Sun, Y. (2009) Evaluation of cardiovascular risk assessment models with respect to the clinical interpretation of atherosclerosis in a different type II diabetes cohort. Summit on Translational Bioinformatics, 1-6.

[15]   Wilson, P.W.F., D’Agostino, R.B., Levy, D., Belanger, A.M., Silbershatz, H. and Kannel, W.B. (1998) Prediction of coronary heart disease using risk factor categories. Circulation, 97, 1837-1847. doi:10.1161/01.CIR.97.18.1837

[16]   Anderson, K.M., Wilson, P.W.F., Odell, P.M. and Kannel, W.B. (1991) An updated coronary risk profile: A statement for health professionals. Circulation, 83, 357-363. doi:10.1161/01.CIR.83.1.356

[17]   Cao, J.J., Arnold, A.M., Manolio, T.A., Polak, J.F., Psaty, B.M., Hirsch, C.H., et al. (2007) Association of carotid artery intima-media thickness, plaques, and C-reactive protein with future cardiovascular disease and all-cause mortality: The cardiovascular health study. Circulation, 116, 32-38. doi:10.1161/CIRCULATIONAHA.106.645606

[18]   Baroncini, L.A.V., de Oliveira, A., Vidal, E. and Precoma, D. (2008) Appropriateness of carotid plaque and intimamedia thickness assessment in routine clinical practice. Cardiovascular Ultrasound, 6, 52. doi:10.1186/1476-7120-6-52

[19]   Hanley, J.A. and McNeil, B.J. (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology, 143, 29-36.

[20]   Sniderman, A.D., Furberg, C.D., Keech, A., Roeters van Lennep, J.E., Frohlich, J., Jungner, I. and Walldius, G. (2003) Apolipoproteins versus lipids as indices of coronary risk and as targets for statin treatment. The Lancet, 361, 777-780. doi:10.1016/S0140-6736(03)12663-3

[21]   Koren-Morag, N., Tanne, D., Graff, E. and Goldbourt, U. (2002) Low-and high-density lipoprotein cholesterol and ischemic cerebrovascular disease: The bezafibrate infarction prevention registry. Archives of Internal Medicine, 162, 993-999. doi:10.1001/archinte.162.9.993

[22]   Tirschwell, D.L., Smith, N.L., Heckbert, S.R., Lemaitre, R.N., Longstreth, W.T. and Psaty, B.M. (2004) Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups. Neurology, 63, 1868-1875. doi:10.1212/01.WNL.0000144282.42222.DA

[23]   Parrinello, G., Colomba, D., Bologna, P., Licata, A., Pinto, A., Paterna, S., Scaglione, R. and Licata, G. (2004) Early carotid atherosclerosis and cardiac diastolic abnormalities in hypertensive subjects. Journal of Human Hypertension, 18, 201-205. doi:10.1038/sj.jhh.1001653

[24]   Benetos, A., Laurent, S., Asmar, R.G. and Lacolley, P. (1997) Large artery stiffness in hypertension. Journal of Hypertension, 15, S89-S97. doi:10.1097/00004872-199715022-00009

[25]   Ridker, P.M. (2003) Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation, 107, 363-369. doi:10.1161/01.CIR.0000053730.47739.3C

[26]   Pearson, T.A., Mensah, G.A., Alexander, R.W., Anderson, J.L., Cannon, R.O., Criqui, M., et al. (2003) Markers of inflammation and cardiovascular disease—Application to clinical and public health practice: A statement for healthcare professionals from the centers for disease control and prevention and the American heart association. Circulation, 107, 499-511. doi:10.1161/01.CIR.0000052939.59093.45

[27]   Niki, E. (2004) Antioxidants and atherosclerosis. Biochemical Society Transactions, 32, 156-159. doi:10.1042/BST0320156

[28]   Jialal, I. and Devaraj, S. (1996) Low-density lipoprotein oxidation, antioxidants, and atherosclerosis: A clinical biochemistry perspective. Clinical Chemistry, 42, 498-506.

[29]   Dublck, M., Hunter, G., Casey, S. and Keen, C. (1987) Aortic ascorbic acid, trace elements and SOD activity in human aneurysmal and occlusive diseases. Proceedings of the Society for Experimental Biology and Medicine, 84, 138-143.

[30]   Carew, T., Schwenke, D.C. and Steinberg, D. (1987) Antiatherogenic effect of probucol unrelated to its hypocholesterolemic effect: Evidence that antioxidants in vivo can selectively inhibit low density lipoprotein degradation in macrophage-rich fatty streaks and slow the progression of atherosclerosis in watanable heritable hyperlipidemic rabbit. Proceedings of the National Academy of Sciences of the United States, 84, 5928-5931. doi:10.1073/pnas.84.21.7725