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Published on: August 28, 2018
Coronary calcium score predicts cardiovascular mortality in diabetes: diabetes heart study
Subhashish Agarwal1, Amanda J Cox, David M Herrington
1Department of Cardiology, Oakwood Hospital and Medical Center, Dearborn, Michigan, USA.
Insights
Coronary artery calcium (CAC) scoring significantly improves cardiovascular disease (CVD) mortality risk prediction in type 2 diabetes mellitus (T2DM) patients beyond traditional Framingham Risk Score (FRS) factors.
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Type 2 diabetes mellitus (T2DM) confers a significantly elevated risk of cardiovascular disease (CVD).
- Current risk prediction models, such as the Framingham Risk Score (FRS), may not fully capture the heightened CVD mortality risk in T2DM patients.
- The incremental value of coronary artery calcium (CAC) scoring in refining CVD risk stratification within this high-risk population remains to be fully elucidated.
Purpose of the Study:
- To determine if coronary artery calcium (CAC) scoring provides additional prognostic information for cardiovascular disease (CVD) mortality in individuals with type 2 diabetes mellitus (T2DM), beyond established Framingham Risk Score (FRS) factors.
- To assess the impact of CAC on risk reclassification using established CVD mortality risk categories.
Main Methods:
- A cohort of 1,123 T2DM participants from the Diabetes Heart Study underwent baseline computed tomography (CT) scans for CAC quantification.
- Logistic regression analysis was employed to evaluate the association between CAC scores and CVD mortality, adjusting for FRS components.
- Areas under the receiver operating characteristic curve (AUC) were compared with and without CAC, and Net Reclassification Improvement (NRI) was calculated to quantify changes in risk prediction.
Main Results:
- During an average follow-up of 7.4 years, 8% of participants experienced fatal cardiovascular events.
- Higher CAC scores were significantly associated with increased odds of CVD mortality, with odds ratios ranging from 2.93 to 11.23 compared to the reference group (CAC 0-9).
- Incorporating CAC into the risk model significantly improved predictive accuracy (AUC increased from 0.70 to 0.75) and led to meaningful risk reclassification (NRI = 0.13).
Conclusions:
- Coronary artery calcium (CAC) scoring is a valuable tool for predicting cardiovascular disease (CVD) mortality in patients with type 2 diabetes mellitus (T2DM).
- CAC meaningfully reclassifies CVD risk in T2DM individuals, enhancing the accuracy of risk stratification beyond traditional risk factors.
- These findings support the clinical utility of CAC scoring in managing cardiovascular risk within the T2DM population.
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.
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