[Frontiers in Bioscience, Landmark, 25, 1132-1171, March 1, 2020]

Low-cost preventive screening using carotid ultrasound in patients with diabetes

Vijay Viswanathan1, Ankush D. Jamthikar2, Deep Gupta2, Nizarudeen Shanu3, Anudeep Puvvula4, Narendra N. Khanna5, Luca Saba6, Tomaz Omerzum7, Klaudija Viskovic8, Sophie Mavrogeni9, Monika Turk10, John R. Laird11, Gyan Pareek12, Martin Miner13, Petros P. Sfikakis14, Athanasios Protogerou15, George D. Kitas16, Chithra Shankar17, Shalini Joshi18, Henreitta Fiscian19, Aba Ankomaba Folson20, Dee H. Wu21, Zoltan Ruzsa22, Andrew Nicolaides23, Aditya Sharma24, Deepak L. Bhatt25, Jasjit S. Suri26

1Professor M Viswanathan Diabetes Research Center, Royapuram, Tamil Nadu, India, 2Department of Elctronics and Communication Engineering, Visvesvaraya National Institute of Technology, Nagpur, India, 3Department of ECE working with College of Engineering Karunagapally, India, 4Annu's Hospitals for Skin and Diabetes, Andhra Pradesh, India, 5Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India, 6Department of Radiology, University of Cagliari, Italy, 7Department of Neurology, University Medical Centre Maribor, Slovenia, 8Department of Radiology and Ultrasound, University Hospital for Infectious Diseases Croatia, 9Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece, 10Department of Neurology, University Medical Centre Maribor, Maribor, Slovenia, 11Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA, 12Minimally Invasive Urology Institute, Brown University, Providence, Rhode Island, USA, 13Men’s Health Center, Miriam Hospital Providence, Rhode Island, USA, 14Rheumatology Unit, National Kapodistrian University of Athens, Greece, 15Department of Cardiovascular Prevention and Research Unit Clinic and Laboratory of Pathophysiology, National and Kapodistrian Univ. of Athens, Greece, 16R and D Academic Affairs, Dudley Group NHS Foundation Trust, Dudley, United kingdom, 17Shree Polyclinic & Lab, Bangalore, India, 18Preventive Health Check, Fortis Hospital, Bannerghatta Road, Bengaluru, India, 19MD, Department of endocrinology, Ridge Hospital, Accra, Ghana, 20Head of Cardiology, Greater Accra Regional Hospital, Ridge, Accra, Ghana, 21Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, USA, 22Semmelweis University, Budapest, Hungary, 23Vascular Screening and Diagnostic Centre and University of Nicosia Medical School, Cyprus, 24Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA, 25Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School, Boston, USA, 26Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA

TABLE OF CONTENTS

1. Abstract
2. Introduction
3. Search strategy
4. A Brief Note on the biology of diabetes and atherosclerosis
    4.1. A brief description of atherosclerosis
    4.2. A brief description of the biology of diabetes
    4.3. Association of atherosclerosis due to diabetes
5. Conventional Screening Tools for CVD Risk Assessment
6. Carotid Ultrasound Screening tools for CVD risk assessment
    6.1. Association of carotid atherosclerosis and CVD/stroke risk
    6.2. Debate on the use of CUSIP for CVD risk assessment
    6.3. Measurement of Carotid Ultrasound Image-based phenotypes
    6.4. Validation of Automated Full-length Measurement
7. Integrated Screening Tools for CVD risk assessment
8. Discussion
    8.1. A special note on clinical trials and case reports in preventive screening
    8.2. Morphology-based risk assessment methods
    8.3. Financial burden of diabetes mellitus in India
    8.4. Manifestations
9. Conclusion
10. Disclosures
11. References

1. ABSTRACT

Diabetes and atherosclerosis are the predominant causes of stroke and cardiovascular disease (CVD) both in low- and high-income countries. This is due to the lack of appropriate medical care or high medical costs. Low-cost 10-year preventive screening can be used for deciding an effective therapy to reduce the effects of atherosclerosis in diabetes patients. American College of Cardiology (ACC)/American Heart Association (AHA) recommended the use of 10-year risk calculators, before advising therapy. Conventional risk calculators are suboptimal in certain groups of patients because their stratification depends on (a) current blood biomarkers and (b) clinical phenotypes, such as age, hypertension, ethnicity, and sex. The focus of this review is on risk assessment using innovative composite risk scores that use conventional blood biomarkers combined with vascular image-based phenotypes. AtheroEdge™ tool is beneficial for low-moderate to high-moderate and low-risk to high-risk patients for the current and 10-year risk assessment that outperforms conventional risk calculators. The preventive screening tool that combines the image-based phenotypes with conventional risk factors can improve the 10-year cardiovascular/stroke risk assessment.

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Abbreviations: ABI Ankle-Brachial Index, ACC American College of Cardiology, ADA American Diabetes Association, AGEs Advanced Glycation End Products, AHA American Heart Association, AUC Area Under Curve, BMI Body Mass Index , BP Blood Pressure, CAD Coronary Artery Disease, CCTA Cardiac Computed Tomography Angiography, CKD Chronic Kidney Disease, CVD Cardiovascular Disease, CCVRF Conventional Cardiovascular Risk Factor, DWT Discrete Wavelet Transform, eNOS Endothelial Nitric Oxide Synthase, ERK5 Extracellular Signal-Regulated Kinase 5, IAD Inter-Adventitial Diameter, ICA Internal Carotid Artery, IDF International Diabetes Federation, MI Myocardial Infarction, PWV Pulse Wave Velocity, SMC Smooth Muscle Cell, STEMI ST-Elevation Myocardial Infarction, SUMO Small Ubiquitin-Like Modifier, T2DM Type-2 Diabetes Mellitus, WHO World Health Organization, SMI Silent Myocardial Infraction, CVE Cardiovascular events, ASCVD Atherosclerotic Cardiovascular Disease, AECRS1.0 AtheroEdgeTM Composite Risk Score 1.0, FRS Framingham Risk Score, NIPPON Based on the NIPPON DATA80, PROCAM Prospective Cardiovascular Münster, RRS Reynolds Risk Score, SCORE Systematic Coronary Risk Evaluation, UKPDS United Kingdom Prospective Diabetes Study, WHO World Health Organization, IMT Intima-Media Thickness, cIMT Carotid IMT, IMTV IMT Variability, IMTavg. Average IMT, IMTmin Minimum IMT, IMTmax. Maximum IMT, LD Lumen Diameter, TPA Total Plaque Area, mTPA Morphological-TPA, gTPA Geometrical-TPA

Key Words: Diabetes, Atherosclerosis, ACC guideline, AHA guideline, Conventional Risk Calculator, 10-year risk assessment, Stroke, Cardiovascular, And Image Phenotypes

Send correspondence to: Jasjit S. Suri, AtheroPoint™, Roseville, Roseville, CA 95661, USA, Tel: 916-749-5628, Fax: 916-749-4942, E-mail: jsuri@comcast.net