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Epidemiology and Prognostic Implications of Coronary Artery Calcium in Asymptomatic Individuals With Prediabetes: A

Mahmoud Al Rifai1, Mouaz H Al-Mallah1, Michael J Blaha2

  • 1Houston Methodist DeBakey Heart & Vascular Center, Houston, TX.

Diabetes Care
|February 8, 2024
PubMed

Insights

Coronary artery calcium (CAC) scoring is frequent in prediabetes and identifies high atherosclerotic cardiovascular disease (ASCVD) risk. Individuals with prediabetes and CAC ≥100 have ASCVD risk similar to those with diabetes.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Epidemiology

Background:

  • Prediabetes affects a significant portion of the adult population.
  • Identifying individuals with prediabetes who are at high risk for atherosclerotic cardiovascular disease (ASCVD) is crucial for timely intervention.
  • Coronary artery calcium (CAC) scoring is a non-invasive imaging technique that quantifies coronary atherosclerosis.

Purpose of the Study:

  • To investigate the prevalence and prognostic significance of coronary artery calcium (CAC) in individuals diagnosed with prediabetes.
  • To compare the risk of ASCVD events in individuals with prediabetes and varying levels of CAC to those with euglycemia and diabetes.

Main Methods:

  • Pooled data from four large prospective cohorts (Multi-Ethnic Study of Atherosclerosis, Heinz Nixdorf Recall Study, Framingham Heart Study, Jackson Heart Study) of participants without clinical ASCVD.
  • Defined prediabetes using two criteria: inclusive (fasting plasma glucose [FPG] 100-125 mg/dL and/or hemoglobin A1c [HbA1c] 5.7-6.4%) and restrictive (FPG 110-125 mg/dL and HbA1c 5.7-6.4%).
  • Assessed CAC scores and followed participants for incident ASCVD events over a median of 14.6 years.

Main Results:

  • Among 13,376 participants, 22% met the inclusive definition of prediabetes.
  • The prevalence of CAC ≥100 was 22% in prediabetes, compared to 17% in euglycemia and 37% in diabetes.
  • Individuals with prediabetes and CAC ≥100 had a significantly higher adjusted risk of ASCVD (Hazard Ratio [HR] 1.54) compared to those with euglycemia and no CAC, with risk comparable to individuals with diabetes (HR 1.64).

Conclusions:

  • A substantial proportion of individuals with prediabetes have significant coronary artery calcification (CAC ≥100).
  • CAC scoring effectively identifies a subgroup of individuals with prediabetes at high risk for future atherosclerotic cardiovascular disease (ASCVD) events.
  • The risk of ASCVD in prediabetic individuals with CAC ≥100 is similar to that observed in individuals with diabetes, highlighting the need for risk stratification and management in this population.
Abstract

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