Silent Vessels: Early Detection of Subclinical Atherosclerosis Using Carotid Ultrasound Elastography in Diabetic Adults

Matteo Romano¹, Giulia Ferrara², Leon Zimmermann³

Abstract

Background: Subclinical atherosclerosis often develops silently in diabetic patients before clinical manifestations of cardiovascular disease. Conventional carotid intima–media thickness (CIMT) may not capture early vessel stiffness changes. Elastography-based vascular imaging could detect biomechanical alterations earlier than structural changes.

Objective: To assess the diagnostic value of carotid shear-wave elastography for early detection of subclinical atherosclerosis in adults with type 2 diabetes mellitus.

Methods: A cross-sectional study was conducted on 412 diabetic adults (mean age 55 ± 9 years) and 128 non-diabetic controls between 2022 and 2024. Ultrasound elastography measured mean carotid wall stiffness (kPa), while CIMT and serum biomarkers (HbA1c, LDL-C, hs-CRP) were recorded. Logistic regression and ROC analysis assessed the predictive value of stiffness for subclinical atherosclerosis (CIMT ≥ 0.9 mm).

Results: Mean stiffness was higher in diabetics (28.3 ± 5.4 kPa) than controls (21.9 ± 4.2 kPa, p < 0.001). Among diabetics, 38.6% had subclinical atherosclerosis. Carotid stiffness ≥ 26 kPa predicted CIMT ≥ 0.9 mm with sensitivity 83% and specificity 78% (AUC 0.88, 95% CI 0.84–0.91). HbA1c ≥ 8% and stiffness ≥ 26 kPa combined yielded an AUC of 0.92. Stiffness correlated with LDL-C (r = 0.46, p < 0.001) and hs-CRP (r = 0.42, p = 0.002).

Conclusion: Carotid elastography detects vascular stiffness preceding structural changes in diabetic adults. Integration into routine screening could improve early identification of atherosclerotic risk before irreversible vessel damage occurs.