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Aims/Introduction  The usefulness of markers of carotid plaque, such as sum ( PS ) and maximum (P‐max) of the plaque thickness, in combination with intima‐media thickness in the common carotid artery ( CIMT ) for the detection of obstructive coronary artery disease ( CAD ) was investigated in patients with type 2 diabetes without known  CAD .    Materials and Methods  B‐mode ultrasonographic scanning of the carotid artery and multislice computed tomography coronary angiography were carried out in 332 asymptomatic patients with type 2 diabetes.    Results  For the presence of obstructive  CAD  when incorporating  PS  or P‐max to standard risk factors in a multiple logistic regression model, the classification ability in  PS  and P‐max increased greatly (area under the curve [ AUC ] 0.827 vs 0.720 [net reclassification index { NRI } = 0.652,  P  < 0.01] and  AUC  0.820 vs 0.720 [ NRI  = 0.775,  P  < 0.01], respectively), and it in  CIMT  increased slightly ( AUC  0.740 vs 0.720,  NRI  = 0.230,  P  = 0.041). Furthermore, the classification abilities for a model with interaction terms between  PS * or P‐max* and  CIMT  were statistically larger than those for a model without interaction terms ( AUC  0.833 vs 0.827 [ NRI  = 0.411,  P  < 0.01] and 0.823 vs 0.820 [ NRI  = 0.269,  P  < 0.05], respectively). Partitioning showed the patients in the values of the  PS  <2.6 mm and  CIMT  <0.725 mm (100%), or in P‐max <2.1 mm and  CIMT  <0.725 mm (95.4%), did not have obstructive  CAD , whereas those in the values of  PS    ≧  2.6 mm, presence of hyperlipidemia and  CIMT    ≧  0.675 mm (84%) or those in the value of P‐max   ≧  2.1 mm and body mass index   ≧  24 (91.7%) had obstructive  CAD .    Conclusions  Although the P‐max and  PS  in the carotid artery were useful as detectors of  CAD , combining them with  CIMT  provided a much superior first‐line screening method in detecting  CAD  in asymptomatic patients with diabetes.

journal of diabetes investigation

Usefulness of carotid plaque (sum and maximum of plaque thickness) in combination with intima‐media thickness for the detection of coronary artery disease in asymptomatic patients with diabetes