Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes.
Aged
Cardiovascular Diseases
/ etiology
Computed Tomography Angiography
Coronary Vessels
/ diagnostic imaging
Diabetes Mellitus, Type 2
/ complications
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Risk Assessment
/ methods
Risk Factors
Vascular Calcification
/ diagnostic imaging
Cardiovascular disease
Coronary artery calcium
Diabetes mellitus
Risk stratification
Journal
BMC cardiovascular disorders
ISSN: 1471-2261
Titre abrégé: BMC Cardiovasc Disord
Pays: England
ID NLM: 100968539
Informations de publication
Date de publication:
13 11 2021
13 11 2021
Historique:
received:
31
08
2021
accepted:
28
10
2021
entrez:
14
11
2021
pubmed:
15
11
2021
medline:
29
1
2022
Statut:
epublish
Résumé
The increased risk for cardiovascular events in diabetics is heterogeneous and contemporary clinical risk score calculators have limited predictive value. We therefore examined the additional value of coronary artery calcium score (CACS) in outcome prediction in type 2 diabetics without clinical coronary artery disease (CAD). The study examined a population-based cohort of type 2 diabetics (n = 735) aged 55-74 years, recruited between 2006 and 2008. Patients had at least one additional risk factor and no history or symptoms of CAD. Risk assessment tools included Pooled Cohort Equations (PCE) and Multi-Ethnic Study of Atherosclerosis (MESA) 10-year risk score calculators and CACS. The occurrence of myocardial infarction (MI), stroke or cardiovascular death (MACE) was assessed over 10-years. Risk score calculators predicted MACE and MI and cardiovascular death individually but not stroke. Increasing levels of CACS predicted MACE and its components independently of clinical risk scores, glycated hemoglobin and other baseline variables: hazard ratio (95% confidence interval) 2.92 (1.06-7.86), 6.53 (2.47-17.29) and 8.3 (3.28-21) for CACS of 1-100, 101-300 and > 300 Agatston units respectively, compared to CACS = 0. Addition of CACS to PCE improved discrimination of MACE [AUC of PCE 0.615 (0.555-0.676) versus PCE + CACS 0.696 (0.642-0.749); p = 0.0024]. Coronary artery calcium was absent in 24% of the study population and was associated with very low event rates even in those with high estimated risk scores. CACS in asymptomatic type 2 diabetics provides additional prognostic information beyond that obtained from clinical risk scores alone leading to better discrimination between risk categories.
Sections du résumé
BACKGROUND
The increased risk for cardiovascular events in diabetics is heterogeneous and contemporary clinical risk score calculators have limited predictive value. We therefore examined the additional value of coronary artery calcium score (CACS) in outcome prediction in type 2 diabetics without clinical coronary artery disease (CAD).
METHODS
The study examined a population-based cohort of type 2 diabetics (n = 735) aged 55-74 years, recruited between 2006 and 2008. Patients had at least one additional risk factor and no history or symptoms of CAD. Risk assessment tools included Pooled Cohort Equations (PCE) and Multi-Ethnic Study of Atherosclerosis (MESA) 10-year risk score calculators and CACS. The occurrence of myocardial infarction (MI), stroke or cardiovascular death (MACE) was assessed over 10-years.
RESULTS
Risk score calculators predicted MACE and MI and cardiovascular death individually but not stroke. Increasing levels of CACS predicted MACE and its components independently of clinical risk scores, glycated hemoglobin and other baseline variables: hazard ratio (95% confidence interval) 2.92 (1.06-7.86), 6.53 (2.47-17.29) and 8.3 (3.28-21) for CACS of 1-100, 101-300 and > 300 Agatston units respectively, compared to CACS = 0. Addition of CACS to PCE improved discrimination of MACE [AUC of PCE 0.615 (0.555-0.676) versus PCE + CACS 0.696 (0.642-0.749); p = 0.0024]. Coronary artery calcium was absent in 24% of the study population and was associated with very low event rates even in those with high estimated risk scores.
CONCLUSIONS
CACS in asymptomatic type 2 diabetics provides additional prognostic information beyond that obtained from clinical risk scores alone leading to better discrimination between risk categories.
Identifiants
pubmed: 34773970
doi: 10.1186/s12872-021-02352-4
pii: 10.1186/s12872-021-02352-4
pmc: PMC8590310
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
541Informations de copyright
© 2021. The Author(s).
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