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Ascending and descending thoracic aorta calcification in type 2 diabetes mellitus
Timothy W Churchill1, Suraj P Rasania2, Hashmi Rafeek3
1Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Insights
Thoracic aortic calcium in diabetics has similar risk factors and coronary artery calcium links for both ascending and descending aorta. Only descending aortic calcium is linked to peripheral arterial disease.
Area of Science:
- Cardiology
- Diabetology
- Vascular Medicine
Background:
- Thoracic aortic calcification is a cardiovascular disease risk factor, but poorly studied in diabetics.
- Ascending and descending aortic calcification may represent distinct phenotypes.
- Previous studies often treat aortic calcium as a single entity.
Purpose of the Study:
- To determine the prevalence of ascending and descending thoracic aortic calcium in type 2 diabetes mellitus (T2DM) patients.
- To assess associations between aortic calcium phenotypes and cardiovascular risk factors.
- To evaluate the relationship of aortic calcium with coronary artery calcium and peripheral arterial disease (PAD).
Main Methods:
- Cross-sectional study within the Penn Diabetes Heart Study.
- Quantified Agatston scores for ascending and descending thoracic aorta in 1739 T2DM subjects.
- Used multivariate logistic and Tobit regressions to analyze associations.
Main Results:
- 54% of subjects had thoracic aortic calcium; 37% had ascending only, 20% descending only.
- Age, race, blood pressure, LDL cholesterol, smoking, and diabetes duration were linked to both aortic calcium types.
- Both aortic calcium types associated with coronary calcium; descending aortic calcium associated with low ankle-brachial index (PAD indicator).
Conclusions:
- Ascending and descending thoracic aortic calcium share similar cardiovascular risk factor associations in diabetics.
- Both phenotypes are independently linked to coronary artery calcium.
- Descending aortic calcification is uniquely associated with peripheral arterial disease, suggesting distinct clinical implications.
Background:
Calcification of the thoracic aorta is a risk factor for cardiovascular disease and peripheral arterial disease but has not been well studied in diabetics. In addition, many studies consider aortic calcium as a single anatomic entity, whereas calcification of the ascending and descending portions of the thoracic aorta may represent separate phenotypes. We sought to characterize the prevalence of ascending and descending aortic calcium among diabetics and to assess their associations with cardiovascular risk factors, coronary artery calcium, and peripheral arterial disease.
Methods:
Within the Penn Diabetes Heart Study, a cross-sectional study of subjects with type 2 diabetes mellitus but without coronary or renal disease, we quantified Agatston scores of the ascending and descending thoracic aorta in 1739 subjects (63% male, 61% Caucasian). Multivariate logistic and Tobit regressions were used to assess associations with cardiovascular risk factors, coronary calcium, and peripheral arterial disease.
Results:
Of all subjects, 54% had thoracic aortic calcium; of these, 37% had calcium solely in the ascending thoracic aorta and 20% solely in the descending thoracic aorta. In multivariate regression, age, Caucasian race, systolic blood pressure, low-density lipoprotein cholesterol, smoking, and diabetes duration were independently associated with calcium of both the ascending and descending thoracic aorta (P < .001 for all). Ascending and descending aortic calcium were each independently associated with coronary calcium in multivariate regression, but only calcification of the descending thoracic aortic was associated with low ankle-brachial index.
Conclusion:
Ascending and descending thoracic aortic calcium have similar associations with traditional cardiovascular risk factors in diabetics and are independently associated with coronary artery calcium. Only calcium in the descending aorta is associated with peripheral arterial disease. Delineation of both phenotypes may provide information about the individualized vascular disease and risk profile of patients with type 2 diabetes mellitus.
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