Avaliação do risco cardiovascular utilizando a idade vascular em pacientes com diabetes mellitus tipo 2

Abstract

There is a wide variety of cardiovascular outcomes in patients with type 2 diabetes (T2DM), even in asymptomatic individuals. The carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and can be considered a predictor of cardiovascular risk. Since risk is multifactorial, the search for non-classical risk factors, such as thyroid function, may contribute to the refinement of these event predictions. Clinical, laboratory, and CIMT parameters were measured in 154 asymptomatic patients with T2DM. The Framingham risk score (FRS) was performed with chronological age (CA) and then with vascular age (VA) determined from CIMT. A multinomial logistic regression model was used to analyze variables related to cardiovascular risk (CVR) reclassification. The use of CIMT for the determination of VA led to the reclassification of 54 (35.52%) out of 152 asymptomatic T2DM patients, being 20 (37.03%) to a lower risk category and 34 (62.96%) to a higher risk category according to FRS. The variables that were associated to reclassification to a higher risk category were: family history (FH) of premature coronary artery disease (p=0.046), FH of thyroid disease (p=0.010), use of statins (p=0.027), and free T4 (p=0.009). In our study, VA determined from CIMT allowed the reclassification of the CVR in asymptomatic T2DM patients. The predicted variables associated to reclassification to a higher risk category were: FH of premature CAD, FH of known thyroid disease, use of statins, and free T4. However, further prospective studies must be performed to evaluate thyroid function as a CV risk marker and establish the predictive values of CIMT on cardiovascular outcomes in asymptomatic patients with T2DM.