Atherosclerosis and diabetes mellitus (DM) are both severe chronic diseases that cause huge burdens on patients' families and societies. Connections between the two diseases have brought high attention recently, however, population-based study with large sample size was few. The study aimed to explore the relationship between carotid atherosclerosis and DM. We enrolled 3908 adults aged 40-74 years from communities and measured their cardio-metabolic profiles and scanned their carotid arteries bilaterally. The overall prevalence rates of carotid plaque and DM were 34.4 and 10.7%, respectively. The age-specific prevalence rates of DM and carotid plaque were nearly linearly correlated in both sexes (both Pearson's correlation coefficient r > 0.97). The prevalence rates of carotid plaque, total plaque number ≥3, maximum diameter stenosis ≥30%, and plaque score ≥3 were 53.6, 24.8, 19.1, and 28.6%, respectively, in DM patients and were 32.1, 9.4, 9.8, and 11.2%, respectively, in non-DM controls. After adjustment for other conventional risk factors, the multivariable-adjusted OR of having carotid plaque was 1.60 (95% CI 1.27-2.01) and were 2.06 (95% CI 1.55-2.75), 1.33 (95% CI 0.99-1.78), and 2.03 (95% CI 1.55-2.65) for total plaque number ≥3, maximum diameter stenosis ≥30%, and plaque score ≥3, respectively. We demonstrated that prevalences of DM were linearly correlated with prevalences of carotid plaque and DM patients had higher prevalence rates of carotid plaque and more advanced carotid atherosclerosis than non-DM controls. Our results indicated the need to address the role of DM in atherosclerosis development.

Background: The assessment of future risk of cardiovascular diseases (CVD) is strongly recommended for all asymptomatic adults without CVD history. Carotid atherosclerosis (CA) is a preclinical phenotype of CVDs. However, data on estimated future CVD risks with respect to preclinical atherosclerosis are limited. This community-based study aimed to assess the relationships between predicted CVD risks and CA. Methods: We enrolled 3908 subjects aged 40–74 years without CVD history and calculated their 10-year CVD risks using the Framingham Risk Score (FRS) and the Pooled Cohort Equations (PCE). Carotid plaque (CP) at the extracranial carotid arteries was determined by high-resolution B-mode ultrasonography and further classified into mild or advanced CA. Results: The means of FRS for CP-negative and mild and advanced CA were 9.0%, 14.4%, and 22.1%, respectively (p-value < 0.0001). The corresponding values for PCE score were 4.8%, 8.8%, and 15.0%, respectively (p-value < 0.0001). The odds ratios (ORs) of having CP per 5.0% increase in FRS and PCE score were 1.23 (95% CI, 1.19–1.28) and 1.36 (95% CI, 1.28–1.44), respectively. The corresponding values of having advanced CA were 1.24 (95% CI, 1.19–1.29) and 1.38 (95% CI, 1.30–1.48), respectively. Among the models of FRS or PCE plus other conventional CVD risk factors, the FRS + age model had the highest discrimination for the presence of CP (AUROC, 0.7533; 95% CI, 0.7375–0.7691) as well as for the presence of advanced CA (AUROC, 0.8034; 95% CI, 0.7835–0.8232). The calibration of the FRS + age models for the presences of CP and advanced CA was excellent (χ² = 8.45 [p = 0.49] and 10.49 [p = 0.31], respectively). Conclusions: Estimated future CVD risks were significantly correlated with risks of having CA. Both FRS and PCE had good discrimination for the presences of CP and advanced CA.

Background: Coronary heart disease (CHD) remains a leading cause of global mortality, often sharing pathophysiologic pathways with cerebrovascular atherosclerosis. Carotid duplex ultrasonography provides a convenient, noninvasive assessment of both vascular structure and hemodynamics. However, the clinical implications of specific carotid flow velocities for predicting CHD risk have not yet been fully explored. Methods: We conducted a case–control study using two community-based cohort datasets from Taiwan’s northern coastal region, enrolling individuals during two periods: from September 2010 to May 2011 and September 2014 to May 2020. Among 4102 participants aged 40–74 years, 45 were excluded for insufficient Doppler waveforms, leaving 4057 eligible subjects. Of these, 165 individuals with physician-confirmed myocardial infarction or prior coronary intervention/surgery were classified as CHD cases; the remaining 3892 served as controls. Carotid blood flow parameters—peak systolic (PSV), end-diastolic (EDV), and time-average maximal flow velocity (MFV), as well as resistance and pulsatility indices (RIs and PIs)—were determined by color Doppler ultrasound at the bilateral common carotid arteries (CCAs). Associations between these measurements and CHD were evaluated through logistic regression, adjusting for conventional cardiovascular risk factors. Results: Participants diagnosed with CHD exhibited significantly lower carotid flow velocities as well as higher RIs and PIs. After multivariable adjustments, right-sided common carotid artery (CCA) flow velocities have a relatively better predictive capacity than left-sided CCA flow velocities. However, left-sided RIs (adjusted OR per 0.1 increase = 1.41, p = 0.027) and PIs (adjusted OR per 1.0 increase = 1.60, p = 0.037) have better predictive value. Right-sided CCA MFV emerged as an independent predictor of CHD which was the most important (adjusted OR per 5.0 cm/s increase = 0.85; 95% CI: 0.77–0.95, p = 0.0038). As compared to subjects with high MFV (≥44.2 cm/s), the multivariable-adjusted OR of having CHD was significantly elevated for subjects with low MFV (<36.02 cm/s; OR = 1.79; 95% CI: 1.13–2.84, p = 0.013). Combinatory analysis further revealed that individuals with low right MFV, particularly when combined with hypertension, had substantially elevated odds of CHD. Conclusions: Reduced right CCA MFV may serve as a clinically informative signal for the presence of CHD. These findings highlight the potential role of detailed carotid Doppler profiling in refining CHD risk assessment, especially among hypertensive patients. Future prospective investigations are warranted to validate the predictive utility of the MFV for coronary events and to explore whether modifying this parameter through targeted interventions can mitigate cardiovascular risk.

Background: Diabetes mellitus (DM) is a major determinant of aging-related vascular diseases. The arterial pulsatility index (PI) and resistance index (RI) are biomarkers of vascular aging. The available data regarding DM with arterial PI and RI are limited. The specific aim of this study was to explore the relationships between DM and the segment-specific PI and RI of the extracranial carotid arteries. Methods: We enrolled 402 DM cases and 3416 non-DM controls from a community-based cohort. Each subject’s blood flow velocities in the extracranial common (CCA), internal (ICA), and external (ECA) carotid arteries were measured by color Doppler ultrasonography and used to calculate PIs and RIs. Results: The DM cases had significantly higher age–sex-adjusted means of carotid RIs and PIs than the non-DM controls (all p-values < 0.005). After controlling for the effects of conventional cardio-metabolic risk factors, all carotid RIs and PIs remained significantly correlated with higher odds ratios (ORs) of having DM. The relationships with DM were stronger and more significant for the ECA RI and PI. The multivariable-adjusted ORs were 1.36 (95% confidence interval [CI], 1.21~1.54, p = 3.9 × 10⁻⁷) and 1.30 (95% CI, 1.17~1.45, p = 8.7 × 10⁻⁷) for 1.0 SD increases in the ECA RI and PI, respectively. Compared to the best fit model of conventional cardio-metabolic risk factors, the additions of the ECA RI and PI significantly increased the area under the receiver operating characteristic curve by 0.85% (95% CI, 0.11~1.59%; p = 0.023) and 0.69% (95% CI, 0.01~1.37%; p = 0.046), respectively. Conclusions: This study shows significantly positive associations between DM and carotid RIs and PIs. Carotid RIs and PIs are potential biomarkers for DM-related vascular diseases.