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Use of cardiovascular imaging in risk restratification of the diabetic patient
Jamie W Bellinge1,2, Sing Ching Lee1,2, Carl J Schultz1,2
1School of Medicine, Faculty of Health and Biomedical Science, University of Western Australia.
Insights
The coronary calcium score (CCS) helps assess cardiovascular disease (CVD) risk in people with diabetes mellitus. It is particularly useful for identifying high-risk individuals when clinical uncertainty exists.
Area of Science:
- Cardiology
- Endocrinology
- Preventive Medicine
Background:
- Diabetes mellitus is not a cardiovascular disease (CVD) risk equivalent, yet optimal risk stratification remains debated.
- Coronary calcium score (CCS) measures atherosclerosis burden and is used for CVD risk stratification in the general population.
Purpose of the Study:
- To review recent data on the role of CCS in cardiovascular risk stratification for individuals with diabetes mellitus.
Main Methods:
- Review of recently published data on CCS utilization in diabetes mellitus patients.
- Analysis of CCS thresholds and their relevance in different diabetic populations.
Main Results:
- Individuals with diabetes mellitus exhibit high 10-year CVD event rates at lower CCS levels than the general population.
- Specific CCS categories are relevant for men and women with diabetes.
- CCS is valuable in cases of increased but difficult-to-quantify CVD risk (e.g., young diabetics, type 1 diabetics).
- Modern CCS techniques involve low radiation doses, making screening and surveillance feasible.
Conclusions:
- CCS effectively quantifies CVD risk in diabetic individuals with clinical uncertainty, identifying those at very high risk.
- Further research is needed to develop effective risk reduction strategies for this population.
Purpose Of Review:
Diabetes mellitus is no longer considered a cardiovascular disease (CVD) risk equivalent, but the optimal methods of risk stratification are a matter of debate. The coronary calcium score (CCS) is a measure of the burden of atherosclerosis and is widely used for CVD risk stratification in the general population. We review recently published data to describe the role of the CCS in people with diabetes mellitus.
Recent Findings:
People with diabetes mellitus have 10-year event rates for CVD and CVD mortality that are considered high, at a much lower level of CCS than the general population. Different categories of CCS are pertinent to men and women with diabetes mellitus. CCS may be particularly useful in clinical settings when CVD risk is known to be increased but difficult to quantify, for example peri-menopausal women, young persons with diabetes, type 1 diabetic individuals and others. With modern techniques, the radiation dose of a CSS has fallen to levels wherein screening and surveillance could be considered.
Summary:
The CCS is able to quantify CVD risk in people with diabetes mellitus when there is clinical uncertainty and identifies those with very high event rates. Future research should aim to identify effective risk reduction strategies in this important group.
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