EDITORIAL March 01, 2017 March 01, 2017

Subclinical carotid vascular disease and risk factors for atherosclerosis in type 1 and type 2 diabetes

DOI: 10.1590/2359-3997000000264

The association of diabetes mellitus, both type 1 (T1DM) and type 2 (T2DM), with increased cardiovascular risk is well known (), but growing evidence has shown a wide heterogeneity in the risk of cardiovascular events in diabetics. Besides clinical evaluation, assessment of subclinical vascular disease, such as screening for coronary artery calcium (CAC), a surrogate marker of atherosclerosis in those with normal renal function, and carotid intimal-media thickness (CIMT), can further stratify risk in diabetics, identifying higher and lower risk groups (). In a sub-study from MESA (Multi-Ethnic Study of Atherosclerosis), for instance, the cardiovascular event rates in individuals with metabolic syndrome or T2DM were as low as in those without these conditions, unless CAC or CIMT were significantly elevated.

In this issue of Archives of Endocrinology and Metabolism, two studies unravel the predictors and risk associated with elevation of CIMT and presence of carotid plaque in two distinct groups of diabetic patients. While a universal concept of “cardiovascular risk equivalent” for the entire diabetic population has been progressively replaced for a more selective categorization within this group, understanding the utility of subclinical disease markers in this context, particularly subclinical carotid disease, still lacks further evidence.

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