Cardiovascular risk profile in subjects with diabetes: Is SCORE2-Diabetes reliable?

• Published in: Cardiovascular diabetology Vol. 24; no. 1; pp. 222 - 12
• Main Authors: Scilletta, Sabrina, Di Marco, Maurizio, Miano, Nicoletta, Capuccio, Stefania, Musmeci, Marco, Bosco, Giosiana, Di Giacomo Barbagallo, Francesco, Martedì, Marina, La Rocca, Francesca, Vitale, Alessio, Scicali, Roberto, Piro, Salvatore, Di Pino, Antonino
• Format: Journal Article
• Language: English
• Published: England BioMed Central 21.05.2025; BMC
• Subjects: Adult; Aged; Arterial stiffness; Arteriosclerosis; Atherosclerosis; Blood pressure; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - physiopathology; Cardiovascular risk; Carotid arteries; Carotid Artery Diseases - diagnosis; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - epidemiology; Carotid Artery Diseases - physiopathology; Carotid Intima-Media Thickness; Cholesterol; Chromatography; Cross-Sectional Studies; Decision Support Techniques; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Disease prevention; Female; Heart Disease Risk Factors; Hemoglobin; High density lipoprotein; Humans; Intima-media thickness; Male; Middle Aged; Predictive Value of Tests; Prognosis; Pulse Wave Analysis; Reproducibility of Results; Risk Assessment; Risk Factors; Risk groups; Sample size; SCORE2-Diabetes; Type 2 diabetes; Ultrasonic imaging; Variables; Vascular Stiffness; Vein & artery diseases; Sydney New South Wales Australia; Australia; Type 2 diabetes; Intima-media thickness; SCORE2-Diabetes; Arterial stiffness; Atherosclerosis; Cardiovascular risk
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-025-02769-7

People living with type 2 diabetes (T2D) are at a two- to four-fold higher risk of developing cardiovascular disease (CVD) compared with those without T2D, making early assessment of their CV risk essential. European Society of Cardiology (ESC) has developed a new model to estimate 10-year CV risk in people with T2D aged ≥ 40 years: SCORE2-Diabetes. Despite its advantages, several aspects remain to be clarified. This study evaluated the association between CV risk stratified by SCORE2-Diabetes and early CV damage assessed through arterial stiffness, intima-media thickness (IMT), and carotid atherosclerosis. Additionally, it examined the agreement between risk stratification by SCORE2 and SCORE2-Diabetes and their concordance with vascular damage. Pulse wave velocity (PWV), IMT, and carotid atherosclerosis were assessed in 179 individuals with T2D aged 40-69 years, categorized into SCORE2-Diabetes risk groups: Low (n = 20), Moderate (n = 29), High (n = 44), and very high (n = 37). Patients with a history of atherosclerotic cardiovascular disease (ASCVD) or severe target organ damage (TOD) constituted another group (ASCVD/TOD, n = 49). PWV was significantly increased from Low to very high and ASCVD/TOD groups (7.2 ± 1.1, 8.7 ± 1.9, 9.8 ± 2.3, 12.8 ± 5.1 and 11.5 ± 3.8 m/s, respectively). Similarly, IMT showed a stepwise increase with risk class (0.68 ± 0.11, 0.78 ± 0.13, 0.83 ± 0.12, 0.86 ± 0.19 and 0.87 ± 0.15 mm, respectively). Patients in very high or ASCVD/TOD group showed a higher prevalence of carotid atherosclerosis than other groups (0%, 17.24%, 11.40%, 37.83% and 40.81%, respectively). No significant differences were found between the very high and ASCVD/TOD groups in any parameter. The correlation between PWV values and increasing CV risk was stronger for SCORE2-Diabetes than for SCORE2. ROC curve analysis showed SCORE2-Diabetes had superior predictive performance for carotid atherosclerosis and high PWV compared to SCORE2 (p = 0.048). Higher PWV, IMT, and carotid atherosclerosis prevalence were associated with increasing CV risk stratified by SCORE2-Diabetes, with no significant differences between the very high and ASCVD/TOD groups. SCORE2-Diabetes demonstrated a better identification of preclinical vascular damage compared to SCORE2, supporting its use as a reliable tool for identifying vascular damage in T2D patients without ASCVD or TOD.