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Coronary Artery Calcium Scores in Older Adults With Diabetes and Their Association With Diabetes-Specific Risk
Olufunmilayo H Obisesan1, Olusola A Orimoloye2, Frances M Wang3
1Department of Internal Medicine, Medstar Union Memorial Hospital, Baltimore, Maryland; Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland.
Insights
Coronary artery calcium (CAC) scores vary in older adults with diabetes. More diabetes risk factors are linked to higher CAC, suggesting CAC could improve cardiovascular risk assessment.
Area of Science:
- Cardiology
- Geriatrics
- Diabetology
Background:
- Coronary artery calcium (CAC) is a validated marker for atherosclerotic cardiovascular disease (ASCVD) risk.
- CAC is not routinely used for ASCVD risk prediction in older adults with diabetes.
- Diabetes-specific risk enhancers are known to increase ASCVD risk.
Purpose of the Study:
- To assess the distribution of CAC in older adults (>75 years) with diabetes.
- To examine the association between CAC and diabetes-specific risk enhancers in this population.
Main Methods:
- Utilized data from the Atherosclerosis Risk in Communities (ARIC) study, including adults >75 years with diabetes.
- Analyzed demographic characteristics and CAC distribution using descriptive statistics.
- Employed multivariable-adjusted logistic regression to assess the association between diabetes-specific risk enhancers and elevated CAC.
Main Results:
- The sample mean age was 79.9 years, with 56.6% women and 62.1% White participants.
- CAC scores were heterogeneous; median CAC was higher with more diabetes risk enhancers.
- Participants with ≥2 diabetes-specific risk enhancers had 2.31 times greater odds of elevated CAC (OR 2.31, 95% CI 1.34–3.98).
Conclusions:
- CAC distribution is heterogeneous in older adults with diabetes.
- The presence of multiple diabetes risk-enhancing factors is associated with a higher CAC burden.
- CAC may aid in cardiovascular disease risk prognostication and assessment in this demographic.
Abstract:
Coronary artery calcium (CAC) is a validated marker of atherosclerotic cardiovascular disease (ASCVD) risk; however, it is not routinely incorporated in ASCVD risk prediction in older adults with diabetes. We sought to assess the CAC distribution among this demographic and its association with "diabetes-specific risk enhancers," which are known to be associated with increased ASCVD risk. We used the ARIC (Atherosclerosis Risk in Communities) study data, including adults aged >75 years with diabetes, who had their CAC measured at ARIC visit 7 (2018 to 2019). The demographic characteristics of participants and their CAC distribution were analyzed using descriptive statistics. Multivariable-adjusted logistic regression models were used to estimate the association between diabetes-specific risk enhancers (duration of diabetes, albuminuria, chronic kidney disease, retinopathy, neuropathy, and ankle-brachial index) and elevated CAC, adjusting for age, gender, race, education level, dyslipidemia, hypertension, physical activity, smoking status, and family history of coronary heart disease. The mean age in our sample was 79.9 (SD 3.97) years, with 56.6% women and 62.1% White. The CAC scores were heterogenous, and the median CAC score was higher in participants with a greater number of diabetes risk enhancers, regardless of gender. In the multivariable-adjusted logistic regression models, participants with ≥2 diabetes-specific risk enhancers had greater odds of elevated CAC than those with <2 (odds ratio 2.31, 95% confidence interval 1.34 to 3.98). In conclusion, the distribution of CAC was heterogeneous among older adults with diabetes, with the CAC burden associated with the number of diabetes risk-enhancing factors present. These data may have implications for prognostication in older patients with diabetes and supports the possible incorporation of CAC in the assessment of cardiovascular disease risk in this population.
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