Coronary calcium in adults with type 1 diabetes: a stronger correlate of clinical coronary artery disease in men than in women.

Olson, Jon C.; Edmundowicz, Daniel; Becker, Dorothy J.; Kuller, Lewis H.; Orchard, Trevor J.

doi:10.2337/diabetes.49.9.1571

Cited by 150 publications

(128 citation statements)

References 44 publications

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“…It is interesting that the reduced arterial calcification in these Hispanic subjects was present despite the fact that levels of traditional and several nontraditional cardiovascular risk factors were similar between the two ethnic groups. Moreover, despite evidence demonstrating that diabetes is strongly associated with increased vascular calcification (25,33), these ethnic differences persisted in this diabetic population. These facts make the finding of reduced CAC and AAC in Hispanics even more impressive.…”

Section: Reaven and Sacksmentioning

confidence: 75%

“…The use of ultrafast electronbeam computed tomography (EBCT) scans to measure vascular calcium has now made this possible. Calcification of the coronary artery intima (CAC) is closely associated with atherosclerosis (21) and appears to be an important predictor of future CVD events (22)(23)(24)(25)(26)(27). In one published study of CAC performed in Hispanics and NHWs who were referred for suspicion of CVD, coronary angiography was performed.…”

mentioning

confidence: 99%

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Reduced Coronary Artery and Abdominal Aortic Calcification in Hispanics With Type 2 Diabetes

Reaven¹,

Sacks²

2004

Diabetes Care

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OBJECTIVE -To compare lifestyle factors, cardiovascular risk factors, and coronary artery calcium (CAC) and abdominal aortic calcium (AAC) levels in Hispanic and non-Hispanic white (NHW) individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS -We recently demonstrated in a small group of nonreferred, healthy, nondiabetic subjects that CAC was reduced in Hispanics compared with NHWs, despite a worse cardiovascular risk factor profile. In this study, we evaluated whether this ethnic disparity in vascular calcification was present in individuals with type 2 diabetes and in several different arterial beds. Hispanic and NHW subjects (n ϭ 245) with type 2 diabetes were evaluated for cardiovascular risk factors using questionnaires and assays of plasma biomarkers. CAC and AAC were measured by electron-beam computer-assisted tomography.RESULTS -Although Hispanics were slightly younger than NHWs, other standard risk factors and novel cardiovascular risk factors, including plasminogen activator-1 and fibrinogen levels, were similar between the groups. Despite the similar risk factor profile, the prevalence of cardiovascular disease (CVD) and mean and median levels of CAC and AAC were lower in Hispanics. Furthermore, the distribution of these calcium scores differed from that of NHWs (P Ͻ 0.05), with significantly fewer Hispanic subjects having high CAC or AAC scores. These differences were not explained by differences in CVD prevalence or any measured lifestyle or risk factor.CONCLUSIONS -Hispanics with type 2 diabetes have reduced CAC and AAC levels compared with NHW subjects, suggesting a reduction in the overall burden of vascular calcification and atherosclerosis. These data are consistent with the notion that Hispanics are protected against the development of CVD. Diabetes Care 27:1115-1120, 2004N umerous studies over the past several decades, using vital statistics data, have demonstrated reduced rates of total and cardiovascular mortality in Hispanics (1-4). Interestingly, epidemiological studies of cardiovascular risk factors have suggested that Hispanics are frequently more obese and insulin resistant compared with non-Hispanic whites (NHWs) and often, as a result, have higher triglyceride levels and lower HDL cholesterol levels (5-13). This apparent decreased rate of cardiovascular disease (CVD) in Hispanics, despite evidence of increased levels of several traditional and nontraditional risk factors, has been described as the "Hispanic paradox" (14,15). However, in several recent longitudinal cohort studies, rates of CVD have appeared equal or possibly greater in Hispanics compared with their NHW counterparts (16 -20). It is important to note that in several of these studies, the comparison between ethnic groups may have been complicated by the greater prevalence and incidence of diabetes in the Hispanic population, which may greatly enhance the overall cardiovascular risk of this ethnic group in comparison with groups having reduced rates of diabetes.To further assess this potential ethnic disparity in th...

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Section: Reaven and Sacksmentioning

confidence: 75%

mentioning

confidence: 99%

Reduced Coronary Artery and Abdominal Aortic Calcification in Hispanics With Type 2 Diabetes

Reaven¹,

Sacks²

2004

Diabetes Care

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“…However, the association between CAC and clinical CVD has not been well studied and appears less consistent in subjects with diabetes. Several studies have shown that diabetes subjects with known vascular disease have higher levels of CAC than those without these conditions [3,15], yet, these studies were conducted in cohorts of type 1 or both type 1 and 2 diabetes subjects. Moreover, the relationship of calcium with clinical cardiovascular disease was only examined in subjects with type 1 diabetes [15].…”

Section: Introductionmentioning

confidence: 99%

“…Several studies have shown that diabetes subjects with known vascular disease have higher levels of CAC than those without these conditions [3,15], yet, these studies were conducted in cohorts of type 1 or both type 1 and 2 diabetes subjects. Moreover, the relationship of calcium with clinical cardiovascular disease was only examined in subjects with type 1 diabetes [15]. Given the younger age of subjects with type 1 diabetes and the resulting tendency to have zero or low scores of CAC in type 1 diabetes, it has been difficult to assess whether the relationship of CAC with CVD is graded or perhaps threshold dependent.…”

Section: Introductionmentioning

confidence: 99%

Coronary artery and abdominal aortic calcification are associated with cardiovascular disease in type 2 diabetes

2005

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Aims/hypothesis: The goals of this study were to determine whether coronary calcium is associated with the presence of clinical cardiovascular disease in individuals with type 2 diabetes and if the measurement of abdominal aortic calcium may have an independent or added benefit as a surrogate marker for clinical vascular disease. Methods: A cross-sectional study of subjects with type 2 diabetes enrolled in seven medical centres in the USA participating in a Veterans Affairs Cooperative Study of glycaemic control. Enrolled subjects included 309 veterans over 40 years of age with type 2 diabetes, with or without stable cardiovascular disease, who had inadequate glycaemic control (HbA 1 c>7.5%) on oral agents and/or insulin. The study assessed lifestyle behaviours, standard cardiovascular risk factors and coronary artery and abdominal aorta calcification by electron beam computed tomography. Results: Subjects with coronary artery or abdominal aorta calcification present had a strikingly higher prevalence of peripheral artery disease, coronary artery disease and all combined cardiovascular disease. Prevalence of each condition increased from 5-to 13-fold with increasing quintiles of coronary artery calcification and from 2-to 3-fold with increasing abdominal aorta calcification. These associations persisted after adjustment for lifestyle behaviours and standard cardiovascular risk factors. Conclusions/ interpretation: These results support the notion that vascular calcium in type 2 diabetes provides additional information beyond that of standard risk factors in identifying the presence of cardiovascular disease. Subclinical measures of atherosclerosis such as arterial calcification may help more precisely stratify these individuals and alert healthcare providers to those individuals who have particularly accelerated atherosclerosis.

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“…It has been shown that diabetic patients have a significantly higher frequency of coronary calcification compared with individuals of the same age in the general population [5,13]. Coronary calcification has been shown to independently predict myocardial infarction (MI) or obstructive CAD in type 1 and type 2 diabetic patients [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

The apolipoprotein A-IV Gln360His polymorphism predicts progression of coronary artery calcification in patients with type 1 diabetes

et al. 2006

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Coronary calcium in adults with type 1 diabetes: a stronger correlate of clinical coronary artery disease in men than in women.

Cited by 150 publications

References 44 publications

Reduced Coronary Artery and Abdominal Aortic Calcification in Hispanics With Type 2 Diabetes

Reduced Coronary Artery and Abdominal Aortic Calcification in Hispanics With Type 2 Diabetes

Coronary artery and abdominal aortic calcification are associated with cardiovascular disease in type 2 diabetes

The apolipoprotein A-IV Gln360His polymorphism predicts progression of coronary artery calcification in patients with type 1 diabetes

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