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November 6, 2020Journal of Atherosclerosis and ThrombosisOpen Access

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

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Why the study?

Because T2DM is no longer considered a coronary risk equivalent and CV risk is heterogeneous, further risk stratification is needed.

Does coronary artery calcium (CAC) score predict long-term cardiovascular outcomes in asymptomatic patients with type 2 diabetes?

Population

2,162 asymptomatic T2DM patients from a Diabetes Shared Care Network

Comparison

Outcomes compared across CAC categories (0, 0 to 100, 100 to 400, >400)

Design

Cohort study

Follow-up

8.4 years

Authors

MLMeng‐Huan LeiLuodong Poh-Ai HospitalYWYulin WuWuhan Polytechnic UniversitySCSheng‐Liang ChungLuodong Poh-Ai Hospital

Discussion

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Overview

CAC may refine CV risk stratification in asymptomatic T2DM; leaves open whether it improves outcomes or warrants routine use.

Key Points

  • Determine the prevalence and clinical predictors of coronary artery calcium (CAC) and evaluate its prognostic value for long-term cardiovascular outcomes in asymptomatic type 2 diabetes.
  • Assessed CAC scores in a cohort of 2,162 asymptomatic patients with type 2 diabetes recruited from a Diabetes Shared Care Network, tracking cardiovascular outcomes in 1,928 patients over 8.4 years of follow-up.
  • Identified multivariable predictors of elevated CAC and calculated hazard ratios for all-cause mortality and major adverse cardiac events across CAC categories using Cox proportional hazards regression.
  • Baseline CAC scores were distributed as CAC=0 (24.2%), 0 < CAC ≤ 100 (41.5%), 100 < CAC ≤ 400 (20.3%), and CAC > 400 (14.7%), with increased CAC independently predicted by age (OR 1.07, 95% CI 1.06–1.08), male sex (OR 1.82, 95% CI 1.54–2.17), diabetes duration (OR 1.07, 95% CI 1.05–1.09), and multiple risk factors (OR 1.94, 95% CI 1.28–2.95).
  • Higher CAC scores strongly correlated with increased event rates, with CAC > 400 vs. CAC=0 yielding an HR of 8.67 for cardiac death and an HR of 10.52 for major cardiac events (p < 0.001).

Structured PICO

Does coronary artery calcium (CAC) score predict long-term cardiovascular outcomes in asymptomatic patients with type 2 diabetes?

P
Population
1,928 asymptomatic adults (aged 40-80 years) with Type 2 Diabetes Mellitus for >1 year, mean age 64.5, 48% male, from Taiwan. Excluded: documented coronary artery disease, typical angina, abnormal resting electrocardiogram, cerebrovascular or peripheral arterial disease, or serious life-threatening illness.
I
Intervention
Coronary artery calcium (CAC) score measurement using 16-slice or 64-slice multi-detector computerized tomography
C
Comparator
Comparison across CAC score categories: CAC=0 (reference), 0 < CAC ≤ 100, 100 < CAC ≤ 400, and CAC > 400
O
Outcome
All-cause mortality and major coronary heart disease (CHD) events (composite of cardiac mortality, acute myocardial infarction, and any coronary revascularization) at a mean follow-up of 8.4 yearshard clinical

In asymptomatic patients with type 2 diabetes, higher coronary artery calcium scores strongly predict long-term all-cause mortality and major coronary heart disease events, offering better risk stratification than traditional risk factors.

Cite This Study

Lei et al. (2020) studied this question.

synapsesocial.com/papers/6a728477e36a167817e3ea25https://doi.org/10.5551/jat.59386

Topics

Coronary artery diseaseCoronary CT angiography
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Potential Implications of Coronary Artery Calcium Testing for Guiding Aspirin Use Among Asymptomatic Individuals With Diabetes2012 · 51 citations
  2. 2Coronary artery calcium for the prediction of mortality in young adults &lt;45 years old and elderly adults &gt;75 years old2012 · 195 citations
  3. 32019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary2019 · 1,202 citations
  4. 4European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts)2007 · 3,758 citations
  5. 52010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults2010 · 1,875 citations