SCORE2-Diabetes correlated moderately with coronary calcium score (R=0.42) and predicted high atherosclerotic burden (C-statistic 0.73) and obstructive CAD (C-statistic 0.79).
Does the SCORE2-Diabetes risk model correlate with coronary atherosclerotic burden and identify high-risk patients better than the classic SCORE2 in individuals with type 2 diabetes?
The SCORE2-Diabetes risk model correlates moderately with coronary artery calcium score and effectively identifies diabetic patients with high atherosclerotic burden or obstructive CAD.
Abstract Introduction Recently, the European Society of Cardiology developed a prediction model (SCORE2-Diabetes) to estimate the 10-year risk of cardiovascular disease (CVD) in individuals with type 2 diabetes, adding diabetes-related variables (i.e. age at diabetes diagnosis, glycated haemoglobin HbA1c and creatinine-based estimated glomerular filtration rate eGFR) to the conventional risk factors included in the SCORE2. While previous population-based studies have indicated a moderate predictive ability of this tool for CVD, its association with coronary atherosclerotic (CAS) burden remains unclear. This study aimed to analyse the relationship between SCORE-2 Diabetes and coronary artery calcium score (CACS) as an indicator of atherosclerotic burden. Methods Individuals 40-69 years with type 2 diabetes and without known CVD were identified from a single-center registry of patients undergoing CACS and coronary CT angiography for to suspected coronary artery disease (CAD). SCORE-2 Diabetes was categorized into risk groups according to the current European guidelines, and CACS was classified into four strata based on Agatston score ranges (0, 0-99, 100-299, or ≥ 300). We assessed the distribution of CACS across risk groups, the correlation between SCORE2-Diabetes and CACS, and the ability of SCORE2-Diabetes to identify patients with high atherosclerotic burden, defined as CACS ≥ 300. Additionally, we compared the performance of SCORE2-Diabetes against the classic SCORE2, intended for individuals without diabetes. Results A total of 149 patients (57% men, mean age 60±7 years) were included. The mean HbA1c, age of diagnosis of diabetes, and eGFR were 7.2±1.3%, 53±10 years and 98±32 mL/min/1.73 m2, respectively. The distribution of patients across risk categories was 3% at moderate risk, 36% at high risk, and 61% at very high risk. The median CACS was 49 (IQR 0-399 AU), with 31% (n=46) of patients having a CACS of 0 and 42% (n=63) presenting CACS values ≥ 100. The distribution of CACS across SCORE2-Diabetes-defined risk groups is presented in Figure 1A. SCORE-2 Diabetes showed a moderate correlation with CACS (Spearman’s R=0.42; p=0.001) and good discriminative ability to identify patients with CACS ≥ 300 (C-statistic of 0.73, 95% CI 0.66-0.81, p0.001). Moreover, SCORE-2 Diabetes also displayed a good predictive value to identify patients with obstructive CAD on coronary CT angiography (C-statistic 0.79, 95% CI 0.74-0.88, p0.001). Compared to SCORE2-Diabetes, the classic SCORE2 showed a numerically lower correlation with CACS (Spearman’s R 0.38, p=0.001) and also lower predictive value to identify patients with CACS ≥ 300 (C-statistic of 0.69, 95% CI 60-0.78, p0.001). Conclusion SCORE2-Diabetes seems to correlate moderately with CACS and have relatively good ability to identify patients with high atherosclerotic burden and/or obstructive CAD. These findings support the use of this new tool to assess cardiovascular risk in diabetic patients.
Pereira et al. (2025) studied this question. SCORE2-Diabetes correlated moderately with coronary calcium score (R=0.42) and predicted high atherosclerotic burden (C-statistic 0.73) and obstructive CAD (C-statistic 0.79).