Non-Invasive Assessment of Subclinical Atherosclerosis in Dyslipidemia and Type 2 Diabetes Mellitus

Dyslipidemia and type 2 diabetes mellitus are prevalent conditions linked to aaugmented risk of atherosclerotic cardiovascular disease (ASCVD). The current review aimed to thoroughly explore non-invasive methods for evaluating subclinical atherosclerosis, predicting cardiovascular risk, and informing treatment strategies, with a specific focus on two imaging techniques: coronary artery calcium (CAC) scoring and computed tomography coronary angiography.

Recent researchhas strengthened the evidence connecting elevated CAC and thoracic aorta calcification to increased cardiovascular event risk in individuals with primary hypercholesterolemia, underscoring the positive impact of statin therapy. Notably, some individuals with dyslipidemia do not show signs of atherosclerosis, suggesting resilient profiles. Additionally, unconventional dyslipidemia markers, such as apolipoprotein B-100 (apoB)-rich lipoprotein particles, including remnant cholesterol and lipoprotein(a), have been linked to greater subclinical atherosclerosis, indicating that residual risk remains even for those achieving low-density lipoprotein cholesterol (LDL-C) targets. In the context of type 2 diabetes mellitus, variability in atherosclerotic burden is evident, with CAC testing proving valuable for cardiovascular risk stratification.

To conclude, non-invasive evaluations of subclinical atherosclerosis can divulge the continuum of ASCVD risk in individuals with dyslipidemia and diabetes mellitus, enabling tailored strategies for cardiovascular disease prevention in primary care settings.

Source:Mszar, R., Katz, M.E., Grandhi, G.R. et al. Subclinical Atherosclerosis to Guide Treatment in Dyslipidemia and Diabetes Mellitus. Curr Atheroscler Rep;2024(26):217–230. https://doi.org/10.1007/s11883-024-01202-w