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Contributors to mortality in high-risk diabetic patients in the Diabetes Heart Study

Amanda J Cox1, Fang-Chi Hsu2, Barry I Freedman3

  • 1Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC.

Diabetes Care
|July 4, 2014
PubMed

Insights

Individuals with type 2 diabetes and high coronary artery calcification (CAC) face varying mortality risks. Modifiable cardiovascular disease (CVD) risk factors, including vascular calcification, significantly impact outcomes in this high-risk group.

Area of Science:

  • Cardiology
  • Endocrinology
  • Public Health

Background:

  • Type 2 diabetes (T2D) and high coronary artery calcification (CAC) identify individuals at elevated cardiovascular disease (CVD) risk.
  • Risk stratification within this high-risk cohort remains crucial for personalized management.
  • Variability in adverse outcomes suggests other contributing factors beyond CAC alone.

Purpose of the Study:

  • To investigate the association between modifiable cardiovascular disease (CVD) risk factors and all-cause mortality in individuals with type 2 diabetes (T2D) and high coronary artery calcification (CAC).
  • To determine if traditional CVD risk factors provide additional prognostic information in a high-risk T2D population with CAC >1,000 mg.

Main Methods:

  • A cohort of 371 European American individuals with T2D and CAC >1,000 mg from the Diabetes Heart Study (DHS) was followed for 8.2 ± 3.0 years.
  • Cox proportional hazards regression models were employed to analyze all-cause mortality.
  • Differences in CVD risk factors between survivors and non-survivors were compared.

Main Results:

  • Higher vascular calcified plaque scores were significantly associated with increased mortality risk (HR 1.31-1.63).
  • Elevated HbA1c, lipids, C-reactive protein, and reduced kidney function also correlated with increased mortality risk (HR 1.1-1.5).
  • Deceased participants had longer T2D duration and lower use of cholesterol-lowering medications.

Conclusions:

  • Vascular calcification and modifiable CVD risk factors offer valuable prognostic information for risk assessment in high-risk T2D patients.
  • The use of cholesterol-lowering medication demonstrated a protective effect against mortality in this cohort.
Abstract

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