Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient

Budoff, Matthew J.; Raggi, Paolo; Beller, George A.; Berman, Daniel S.; Druz, Regina S.; Malik, Shaista; Rigolin, Vera H.; Weigold, Wm. Guy; Soman, Prem

doi:10.1016/j.jcmg.2015.11.011

Cited by 90 publications

(55 citation statements)

References 152 publications

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“…Recent studies have shown that MiVD in patients with T2D and diagnosed HFpEF is highly prevalent and associated with HF severity and worse outcome; however, ours is the first to show the independent prognostic association between MiVD and development of HFpEF. Echocardiographic studies have shown that T2D is associated with abnormalities of diastolic function independent of the presence of coronary artery disease . In addition, the presence of MiVD in patients with T2D also seems to be associated with the presence of diastolic dysfunction .…”

Section: Discussionmentioning

confidence: 99%

Microvascular disease and heart failure with reduced and preserved ejection fraction in type 2 diabetes

et al. 2020

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Aims Identification of patients with type 2 diabetes (T2D) at increased risk of incident heart failure (HF) beyond traditional risk factors such as prior myocardial infarction (MI) might allow selection of patients who would benefit from preventative treatment. Microvascular disease (MiVD) is thought to play a pathophysiological role in the development of HF in T2D; however, its association with new-onset HF with reduced or preserved ejection fraction has not been specifically defined. Methods and results Patients in the Genetics of Diabetes Audit and Research Tayside Scotland study were linked to echocardiography, prescriptions, and clinical outcomes. In total, 9141 patients with T2D were identified for analysis. Clinical variables and the presence of retinopathy, nephropathy, and neuropathy were assessed. Cumulative incidence was calculated for the association of both individual and the total number of MiVD states and incident HF. Median follow-up was 9.3 years. In total, there were 900 HF events. The presence of any MiVD was independently associated with both HF with reduced ejection fraction (hazard ratio 1.40; 95% confidence interval 1.11-1.76, P = 0.004) and HF with preserved ejection fraction (hazard ratio 1.38; 95% confidence interval 1.10-1.72, P = 0.005), with a stepwise association between the number of MiVD states and risk of incident HF (P for trend <0.001). Similar associations were found in sensitivity analyses limited to patients without a prior MI, and using competing risks analysis. Conclusions Individuals with T2D and with MiVD are at risk of incident HF independent of a history of prior HF or MI. Patients with MiVD could benefit from screening for HF and individualized therapy with treatments that lower HF risk.

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Section: Discussionmentioning

confidence: 99%

Microvascular disease and heart failure with reduced and preserved ejection fraction in type 2 diabetes

et al. 2020

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“…39 In addition, the Imaging Council of the American College of Cardiology recently concluded that CAC screening is the most sensitive noninvasive risk stratification tool among asymptomatic persons with diabetes. 40 Although screening for CHD in patients with diabetes has previously been found to not be of benefit in reducing CHD and ASCVD events, 41,42 other reports 43–45 have found that patient awareness of an abnormal CAC score and coronary CT angiography results is associated with increased adherence to preventive therapies, lifestyle changes, and improvement in lipid levels and other risk factors, suggesting that CAC screening might help to support behavioral modification. In addition, Nasir et al 46 found that CAC screening in MESA participants without diabetes can help identify those at adequately high risk who would benefit from statin therapy (and those at low risk who would not benefit).…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Calcium Score for Long-term Risk Classification in Individuals With Type 2 Diabetes and Metabolic Syndrome From the Multi-Ethnic Study of Atherosclerosis

et al. 2017

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IMPORTANCE Although the risk of type 2 diabetes is considered to be equivalent to coronary heart disease (CHD) risk, there is considerable heterogeneity among individuals for CHD and atherosclerotic cardiovascular disease (ASCVD) risk. It is not known whether coronary artery calcium (CAC) assessment at baseline in individuals with established metabolic syndrome (MetS) or diabetes identifies CHD and ASCVD prognostic indicators during a long follow-up period. OBJECTIVE To compare improvement in long-term prognostication of incident CHD and ASCVD using CAC scores among those with diabetes, MetS, or neither condition. DESIGN, SETTING, AND PARTICIPANTS This study included participants from the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study of 6814 males and females aged 45 to 84 years without known CVD from 4 race/ethnicity groups (white [38.5%], African American [27.5%], Hispanic [22.1%], and Chinese [11.9%]) recruited from 6 US communities from July 2000 through August 2002. Follow-up for each participant extended to the first occurrence of an incident event, other death, loss to follow-up, or the last follow-up call through December 31, 2013. Data analysis was performed from June 1, 2016, to September 12, 2017. Cox proportional hazards regression models were used to estimate hazard ratios (HRs). Area under the receiver operator characteristic curve and net reclassification improvement were used to compare incremental contributions of CAC score when added to the Framingham risk score, ethnicity/race, and socioeconomic status. MAIN OUTCOMES AND MEASURES CHD events, including myocardial infarction, resuscitated cardiac arrest, or CHD death. RESULTS Of 6814 MESA participants, 6751 had complete risk factor and follow-up data and were included in this study (mean [SD] age, 62.2 [10.2] years; 3186 [47.2%] male). A total of 881 (13.0%) had diabetes, 1738 (25.7%) had MetS, and 4132 (61.2%) had neither condition. After 11.1 mean years of follow-up, CHD events occurred in 84 participants with diabetes (135 ASCVD events), 115 with MetS (175 ASCVD events), and 157 with neither (250 ASCVD events). The CAC score was independently associated with incident CHD in multivariable analyses in those with diabetes (HR, 1.30; 95% CI, 1.19–1.43), MetS (HR, 1.30; 95% CI, 1.20–1.41), and neither condition (HR, 1.37; 95% CI, 1.27–1.47). For incident CHD, net reclassification improvement with addition of CAC score was 0.23 (95% CI, 0.10–0.37) in those with diabetes, 0.22 (95% CI, 0.09–0.35) in those with MetS, and 0.25 (95% CI, 0.15–0.35) in those with neither condition. The CAC score was also a prognostic indicator of CHD and ASCVD after controlling for diabetes duration of 10 years or longer at baseline, insulin use, and glycemic control. CONCLUSIONS AND RELEVANCE In a large multiethnic cohort, the addition of CAC score to global risk assessment was associated with significantly improved risk classification in those with MetS and diabetes, even if diabetes duration was longer than a decade, suggesting a ...

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“…Its ability to visualise the coronary arteries, typically measuring 3–4 mm in diameter, stems from its high spatial resolution 25 26. CTCA is primarily used to assess patients with low to intermediate pretest probability of significant coronary artery disease,27 but could potentially be used in the CV risk assessment of patients with RA.…”

Section: Imaging Modalitiesmentioning

confidence: 99%

The role of non-invasive cardiovascular imaging in the assessment of cardiovascular risk in rheumatoid arthritis: where we are and where we need to be

et al. 2016

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Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient

Cited by 90 publications

References 152 publications

Microvascular disease and heart failure with reduced and preserved ejection fraction in type 2 diabetes

Microvascular disease and heart failure with reduced and preserved ejection fraction in type 2 diabetes

Coronary Artery Calcium Score for Long-term Risk Classification in Individuals With Type 2 Diabetes and Metabolic Syndrome From the Multi-Ethnic Study of Atherosclerosis

The role of non-invasive cardiovascular imaging in the assessment of cardiovascular risk in rheumatoid arthritis: where we are and where we need to be

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