Coronary calcium score predicts cardiovascular mortality in diabetes: diabetes heart study

Subhashish Agarwal, Amanda J Cox, David M Herrington, Neal W Jorgensen, Jianzhao Xu, Barry I Freedman, J Jeffrey Carr, Donald W Bowden, Subhashish Agarwal, Amanda J Cox, David M Herrington, Neal W Jorgensen, Jianzhao Xu, Barry I Freedman, J Jeffrey Carr, Donald W Bowden

Abstract

Objective: In type 2 diabetes mellitus (T2DM), it remains unclear whether coronary artery calcium (CAC) provides additional information about cardiovascular disease (CVD) mortality beyond the Framingham Risk Score (FRS) factors.

Research design and methods: A total of 1,123 T2DM participants, ages 34-86 years, in the Diabetes Heart Study followed up for an average of 7.4 years were separated using baseline computed tomography scans of CAC (0-9, 10-99, 100-299, 300-999, and ≥1,000). Logistic regression was performed to examine the association between CAC and CVD mortality adjusting for FRS. Areas under the curve (AUC) with and without CAC were compared. Net reclassification improvement (NRI) compared FRS (model 1) versus FRS+CAC (model 2) using 7.4-year CVD mortality risk categories 0% to <7%, 7% to <20%, and ≥20%.

Results: Overall, 8% of participants died of cardiovascular causes during follow-up. In multivariate analysis, the odds ratios (95% CI) for CVD mortality using CAC 0-9 as the reference group were, CAC 10-99: 2.93 (0.74-19.55); CAC 100-299: 3.17 (0.70-22.22); CAC 300-999: 4.41(1.15-29.00); and CAC ≥1,000: 11.23 (3.24-71.00). AUC (95% CI) without CAC was 0.70 (0.67-0.73), AUC with CAC was 0.75 (0.72-0.78), and NRI was 0.13 (0.07-0.19).

Conclusions: In T2DM, CAC predicts CVD mortality and meaningfully reclassifies participants, suggesting clinical utility as a risk stratification tool in a population already at increased CVD risk.

Figures

Figure 1
Figure 1
OR for cardiovascular mortality with higher CAC scores in the DHS cohort compared with CAC score

Figure 2

Receiver operating characteristic curve analysis…

Figure 2

Receiver operating characteristic curve analysis depicting AUC with and without CAC to predict…

Figure 2
Receiver operating characteristic curve analysis depicting AUC with and without CAC to predict CVD mortality. (A high-quality color representation of this figure is available in the online issue.)
Figure 2
Figure 2
Receiver operating characteristic curve analysis depicting AUC with and without CAC to predict CVD mortality. (A high-quality color representation of this figure is available in the online issue.)

References

    1. Sarwar N, Gao P, Seshasai SR, et al. Emerging Risk Factors Collaboration Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010;375:2215–2222
    1. Wilson PW. Diabetes mellitus and coronary heart disease. Am J Kidney Dis 1998;32(Suppl. 3):S89–S100
    1. Grundy SM, Benjamin IJ, Burke GL, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1999;100:1134–1146
    1. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA 1979;241:2035–2038
    1. Wagenknecht LE, Bowden DW, Carr JJ, Langefeld CD, Freedman BI, Rich SS. Familial aggregation of coronary artery calcium in families with type 2 diabetes. Diabetes 2001;50:861–866
    1. Everhart JE, Pettitt DJ, Knowler WC, Rose FA, Bennett PH. Medial arterial calcification and its association with mortality and complications of diabetes. Diabetologia 1988;31:16–23
    1. Arad Y, Newstein D, Cadet F, Roth M, Guerci AD. Association of multiple risk factors and insulin resistance with increased prevalence of asymptomatic coronary artery disease by an electron-beam computed tomographic study. Arterioscler Thromb Vasc Biol 2001;21:2051–2058
    1. Schurgin S, Rich S, Mazzone T. Increased prevalence of significant coronary artery calcification in patients with diabetes. Diabetes Care 2001;24:335–338
    1. Hoff JA, Quinn L, Sevrukov A, et al. The prevalence of coronary artery calcium among diabetic individuals without known coronary artery disease. J Am Coll Cardiol 2003;41:1008–1012
    1. Detrano R, Guerci AD, Carr JJ, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358:1336–1345
    1. Raggi P, Shaw LJ, Berman DS, Callister TQ. Prognostic value of coronary artery calcium screening in subjects with and without diabetes. J Am Coll Cardiol 2004;43:1663–1669
    1. Folsom AR, Kronmal RA, Detrano RC, et al. Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA). Arch Intern Med 2008;168:1333–1339
    1. Polonsky TS, McClelland RL, Jorgensen NW, et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 2010;303:1610–1616
    1. Erbel R, Möhlenkamp S, Moebus S, et al. Heinz Nixdorf Recall Study Investigative Group Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study. J Am Coll Cardiol 2010;56:1397–1406
    1. Elias-Smale SE, Proença RV, Koller MT, et al. Coronary calcium score improves classification of coronary heart disease risk in the elderly: the Rotterdam study. J Am Coll Cardiol 2010;56:1407–1414
    1. Agarwal S, Morgan T, Herrington DM, et al. Coronary calcium score and prediction of all-cause mortality in diabetes: the diabetes heart study. Diabetes Care 2011;34:1219–1224
    1. Pencina MJ, D'Agostino RB Sr, D'Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond. Stat Med 2008;27:157–172; discussion 207–212.
    1. Bowden DW, Cox AJ, Freedman BI, et al. Review of the Diabetes Heart Study (DHS) family of studies: a comprehensively examined sample for genetic and epidemiological studies of type 2 diabetes and its complications. Rev Diabet Stud 2010;7:188–201
    1. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499–502
    1. Carr JJ, Crouse JR, 3rd, Goff DC, Jr, D’Agostino RB, Jr, Peterson NP, Burke GL. Evaluation of subsecond gated helical CT for quantification of coronary artery calcium and comparison with electron beam CT. AJR Am J Roentgenol 2000;174:915–921
    1. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29–36
    1. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 2004;291:210–215
    1. LaMonte MJ, FitzGerald SJ, Church TS, et al. Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and women. Am J Epidemiol 2005;162:421–429
    1. Anand DV, Lim E, Hopkins D, et al. Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy. Eur Heart J 2006;27:713–721
    1. Elkeles RS, Godsland IF, Feher MD, et al. PREDICT Study Group Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study. Eur Heart J 2008;29:2244–2251
    1. Arad Y, Goodman KJ, Roth M, Newstein D, Guerci AD. Coronary calcification, coronary disease risk factors, C-reactive protein, and atherosclerotic cardiovascular disease events: the St. Francis Heart Study. J Am Coll Cardiol 2005;46:158–165
    1. Wackers FJ, Young LH, Inzucchi SE, et al. Detection of Ischemia in Asymptomatic Diabetics Investigators Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care 2004;27:1954–1961
    1. Thomas GS, Miyamoto MI, Morello AP, 3rd, et al. Technetium 99m sestamibi myocardial perfusion imaging predicts clinical outcome in the community outpatient setting. The Nuclear Utility in the Community (NUC) Study. J Am Coll Cardiol 2004;43:213–223
    1. Kang X, Berman DS, Lewin H, et al. Comparative ability of myocardial perfusion single-photon emission computed tomography to detect coronary artery disease in patients with and without diabetes mellitus. Am Heart J 1999;137:949–957

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться