Coronary calcium score predicts cardiovascular mortality in diabetes

Agarwal S, Cox AJ, Herrington DM, et al. Coronary calcium score predicts cardiovascular mortality in diabetes . Diabetes Care. 2013;36(4):972-977.

Background 

Diabetes is a coronary heart disease (CHD) risk equivalent. The high overall mortality seen with diabetes is driven by increased cardiovascular mortality. In fact, coronary artery disease (CAD) is the most common cause of death in type 2 diabetes, and all cardiovascular disease (CVD) manifestations are two times more common among patients with type 2 diabetes. Individuals with diabetes have significant CVD, which is reflected as a coronary artery calcium (CAC) score.

In the Diabetes Heart Study, the authors sought to examine whether CAC provides additional prognostic information regarding CVD mortality—beyond traditional Framingham Risk Score (FRS) factors—among patients with type 2 diabetes (Click here for slide) 

 Design  

The Diabetes Heart Study examined the risk of cardiovascular disease (CVD) mortality among patients with type 2 diabetes across a range of CAC scores. The study also evaluated the extent to which adding CAC to a prediction model based on FRS factors accurately stratifies future CVD mortality risk among patients with type 2 diabetes. The study enrolled 1,123 patients with type 2 diabetes: mean age, 61 years; 86% had CAC score ≥10; average follow-up, 7.4 years. The primary endpoint was cardiovascular mortality after CAC screening. (Click here for slide) 

Results  

Over 7.4 years of follow-up in the Diabetes Heart Study, 92 deaths were attributed to CVD: (Click here for slide) 

  • Myocardial infarction: 40
  • CAD: 24
  • Cardiac arrest: 12
  • Congestive heart failure: 12
  • Stroke: 4

There was an increased incidence of CVD mortality across higher categories of CAC (P<0.0001). The odds ratios (95% CI) for CVD mortality using CAC scores 0-9 as the reference group were: (Click here for slide) 

  • CAC 10-99: 2.93 (0.74-19.55; P=0.13)
  • CAC 100-299: 3.17 (0.70-22.22; P=0.13)
  • CAC 300-999: 4.41 (1.15-29.0; P=0.03)
  • CAC ≥1,000: 11.23 (3.24-71.0; P=0.0001)

 

 

February 2013 

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Last Modified: 8/5/2014