Coronary Artery Calcium Score Predicts Long-Term Cardiovascular Outcomes in Asymptomatic Patients with Type 2 Diabetes

Abstract

Type 2 diabetes mellitus (T2DM) is no longer regarded as a coronary risk equivalent, and heterogeneity of cardiovascular risk exists, suggesting that further risk stratification should be mandatory. This study aimed to determine the prevalence and clinical predictors of coronary artery calcium (CAC) score, and evaluate the CAC score as a predictor of cardiovascular outcome in a large asymptomatic T2DM cohort. Methods: A total of 2,162 T2DM patients were recruited from a Diabetes Shared Care Network and the CAC score was measured. Cardiovascular outcomes were obtained for 1,928 patients after a follow-up of 8.4 years. Multiple regression analysis and Cox proportional hazard regression were applied to identify clinical predictors of CAC and calculate the incidence and hazard ratios (HRs) for all-cause mortality and cardiovascular events by CAC category. Results: Of the recruited patients, 96.8% had one or more risk factors. The distribution of CAC scores was as follows: CAC 0 in 24.2% of the patients, 0 CAC ≤ 100 in 41.5%, 100 CAC ≤ 400 in 20.3%, CAC 400 in 14.7%. The multivariable predictor of increased CAC included age (years) (odds ratio, 1.07; 95% confidence interval, 1.06-1.08), male sex (1.82; 1.54-2.17), duration (years) of T2DM (1.07; 1.05-1.09), and multiple risk factors (1.94; 1.28-2.95). Increasing severity of CAC was associated with higher all-cause or cardiac mortality and higher incident cardiovascular events. The HRs for cardiac death or major cardiac events in CAC 400 vs CAC 0 were 8.67 and 10.52, respectively (p 0.001) Conclusion: CAC scoring provides better prognostication of cardiovascular outcome than traditional risk factors in asymptomatic T2DM patients, and may allow identifying a high-risk subset for enhancing primary prevention. without diabetes 1-3). From a pooled analysis of more than one million Asian participants, patients with diabetes had a 1.89-fold risk of all-cause death and a twofold risk of cardiovascular-related death compared with patients without diabetes 4). Two decades ago, diabetes was regarded as a "CHD risk equivalent," implying a 10-year cardiovascular risk of 20% for every diabetic patient according to Haffner's report 5) and other large observational studies 6, 7). However, several studies of different population cohorts provided varying conclusions on the concept of coronary risk Copyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

The impact of diabetes and subclinical hypothyroidism association with coronary artery calcium: results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

“…(2017) found that lower and higher TSH levels were associated with CAC showing a U-shaped curve in women but not in men ( 20 , 21 ). The association between diabetes and atherosclerosis as we report it here is well known ( 48 – 50 ). The CAC score in patients with diabetes help in risk stratification of patients with diabetes and intermediary risk ( 50 , 51 ).…”

Clinical Outcomes and Unique Restenosis of Calcified Nodule in Heavily Calcified Coronary Artery

“…Although the usage of debulking devices such as rotational atherectomy (RA) can be helpful to improve delivery and expansion of stents in the calcified lesions, patients with heavily calcified lesions showed poor long-term clinical outcomes even if debulking devices were used 5,6) . As atherosclerotic plaque progresses, the amount of calcification associated with cardiovascular events increases [8][9][10][11] . Among various types of calcification, calcified nodule (CN) is thought to be a more advanced and unique form of calcification characterized by nodular calcification and the guidewire was inserted into the vessel and reached a far distal coronary segment.…”

How dysregulation of the immune system promotes diabetes mellitus and cardiovascular risk complications

“…As described above, patients with diabetes develop an accelerated and more severe form of atherosclerosis cardiovascular disease (ACVD), with a 3–4 times higher risk of suffering a CV event compared to the general population ( 5 , 42 , 43 ). However, there is an important heterogeneity of the CV risk among patients with DM.…”

“…However, there is an important heterogeneity of the CV risk among patients with DM. For example in patients with T2D, the incidence of a major CV event is estimated at 10.5 times higher in individuals with a CAC score >400 compared to those with a zero CAC score ( 42 ). Likewise in patients with T1D, the analysis of the EURODIAB prospective complications study revealed a reduced CV risk (0.37, 95% CI [0.18–0.76]) in patients presenting with at least 4 favorable health metrics, notably including the lower tertiles of systolic blood pressure and HbA1c levels ( 43 ).…”