Progression of Coronary Artery Calcium and Occurrence of Myocardial Infarction in Patients With and Without Diabetes Mellitus

Abstract

Abstract-Progression of coronary artery calcium, a marker of atherosclerosis, can be slowed with statins, and continued progression of calcium is associated with an increased risk of myocardial infarction. However, it is not known whether statins are effective in slowing calcium progression in diabetes mellitus. In a retrospective study, we examined 1153 nondiabetic and 157 diabetic subjects who underwent sequential electron beam tomography scans at a minimum 1-year interval to assess progression of coronary calcium. A yearly score increase Ͼ15% was considered evidence of true progression. The use of statins and occurrence of myocardial infarction were recorded. There was no difference in baseline calcium score between diabetic and nondiabetic patients. Diabetic patients with no coronary calcium on the baseline scans developed it more often than nondiabetic subjects (42% versus 25%; Pϭ0.046) during follow-up. Calcium progression was 33% greater in diabetic patients than nondiabetic subjects (PϽ0.001) if no statin therapy was provided and 17.7% greater when statins were used (PϽ0.001). Among the 49 subjects who experienced a myocardial infarction, the calcium score increased on average 20% more in diabetic than nondiabetic patients (PϽ0.001). In logistic models, diabetes mellitus and systemic hypertension were the best predictors of calcium progression (odds ratio, 3.1 and 1.9, respectively), whereas baseline calcium score percentile and statin therapy were the best predictors of infarction. These findings support the notion that diabetes mellitus causes accelerated atherosclerosis, even in the presence of statin therapy, and provide evidence that coronary calcium monitoring is an effective method to assess treatment efficacy.

Plaque progression assessed by a novel semi-automated quantitative plaque software on coronary computed tomography angiography between diabetes and non-diabetes patients: A propensity-score matching study

“…Clinical evidence of the association between diabetes and the progression in coronary atherosclerosis was also described by others. Raggi et al found that, in diabetic patients, CAC progression was 17.7e33% greater compared to non-diabetic patients [25]. Similarly, our group has demonstrated that annual CAC progression in the diabetes group was approximately 3-fold greater than in the non-diabetes group [26].…”

Coronary Artery Calcification in the Asian Population: An Overview of the Results from the Korea Initiatives on Coronary Artery Calcification Registry

“…Prior studies have documented that coronary calcification progression is associated with unfavorable cardiovascular prognosis [60][61][62]. Serial CACS evaluation has the potential not only to monitor coronary atherosclerosis progression, but also to evaluate or monitor the effectiveness of medical therapies for minimizing adverse cardiovascular risk.…”

ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring by Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain

“…There have been 3 reports from the work of Raggi and colleagues on the relationship between changes in CAC score and outcomes (67)(68)(69). In these studies including a…”