Ischemia imaging and plaque imaging in diabetes: complementary tools to improve cardiovascular risk management
Paolo Raggi1, Antonio Bellasi, Carlo Ratti
1Section of Cardiology, Tulane University School of Medicine, Tulane University, New Orleans, LA 70112, USA. praggi@tulane.edu
Insights
Diabetic patients face higher cardiovascular risks. New cardiovascular imaging tools, including plaque imaging, help better assess risk and guide aggressive management for coronary artery disease (CAD).
Area of Science:
- Cardiology
- Diabetology
- Medical Imaging
Background:
- Cardiovascular disease (CVD) is the leading cause of death and disability in diabetic individuals.
- Diabetics have a 2-4 times higher risk of coronary artery disease (CAD) morbidity and mortality compared to non-diabetics.
- Traditional risk factors inadequately explain the elevated cardiovascular risk in diabetes, and events are often silent.
Purpose of the Study:
- To review current literature on cardiovascular imaging for risk stratification in diabetic patients.
- To evaluate traditional imaging modalities for obstructive CAD and atherosclerosis plaque imaging.
- To identify tools for better risk assessment and management of diabetic individuals with high cardiovascular risk.
Main Methods:
- Review of literature on traditional imaging modalities for obstructive CAD (nuclear and echocardiographic stress testing).
- Assessment of atherosclerosis plaque imaging techniques (carotid intima-media thickness and coronary artery calcium).
- Focus on risk stratification utility in diabetic patients.
Main Results:
- Cardiovascular imaging is crucial for improving risk assessment in diabetic patients.
- Traditional methods assess obstructive CAD, but acute coronary syndromes can occur without significant luminal stenosis.
- Atherosclerosis plaque imaging offers insights into presymptomatic disease stages.
Conclusions:
- Advanced cardiovascular imaging is essential for accurate risk stratification in diabetic patients.
- Integrating plaque imaging with traditional stress tests can enhance the identification of high-risk individuals.
- Improved risk assessment facilitates timely and aggressive management of cardiovascular disease in diabetes.
Abstract:
Cardiovascular disease is the most frequent cause of death and disability in diabetes, and the morbidity and mortality for coronary artery disease (CAD) in this population is two to four times higher than in nondiabetic subjects. Traditional risk factors do not fully explain the level of cardiovascular risk, and coronary disease events are often silent in diabetic patients. Thus, research has recently focused on improving the risk assessment of an individual patient with new tools in an effort to better identify subjects at highest risk and in need of aggressive management. Cardiovascular imaging has proven very helpful in this regard. Traditional methods to assess CAD are based on detection of obstructive luminal disease responsible for myocardial ischemia. However, acute coronary syndromes often occur in the absence of luminal stenoses. Hence, the utilization of imaging methodologies to visualize atherosclerosis in its presymptomatic stages has received mounting attention in recent years. In this article, we review the current literature on the utility of traditional imaging modalities for obstructive CAD (nuclear and echocardiographic stress testing) as well as atherosclerosis plaque imaging with carotid intima-media thickness and coronary artery calcium for risk stratification of diabetic patients.
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