Coronary Artery Disease Risk Assessment by Coronary Artery Calcium Scoring in Asymptomatic Thai People with Diabetes...

People with diabetes mellitus (DM) remain at high risk of cardiovascular (CV) disease. The use of coronary artery calcium (CAC) has been demonstrated as the most powerful CV risk indicator and surrogate marker for the overall vascular health in the asymptomatic population.

This study aimed to find the severity of CAC in asymptomatic Thai people with DM, evaluate the correlation of the severity CAC risk scoring system with different CV risk scores, and examine the impacts of CAC testing on patient managements. ABC control, defined as the proportion of individuals meeting glycemic, blood pressure, and LDL cholesterol targets together, was assessed at 6 months after the CAC measurement.

A total of 157 patients (female 45.2%, T2D 93.0%, mean age 61.7±13.3 years, mean DM duration 12.4±10.6 years, BMI 26.4±4.8 kg/m², A1C 7.4±1.9%, insulin usage 28.7%) were included in the study. Zero calcium score was found in 24.2% and CAC score ≥100 AU was found in 40.3% of all patients. There was a weak to moderate significant positive correlation (correlation coefficients ranged from 0.311 to 0.449) between different CV risk scores with the presence of CAC score ≥100 AU. In those with CAC score ≥ 100 AU, aggressive lipid-lowering therapy, new prescription of SGLT2i or GLP-1 RA, new prescription of antiplatelet as primary prevention was all increased when compared with CAC <100 AU. At 6 months, achieved ABC target increased from 30.4% to 55.7% in patients with CAC ≥100 AU while achieved ABC target increased from 35.9% to 56.4% in patients with CAC < 100 AU.

CAC is an effective tool for CV risk stratification among asymptomatic people with DM and could improve metabolic target attainment rates. Currently available clinical risk assessment models including diabetes-specific risk scores correlated weakly with results from CAC testing among Thai people with DM.