Coronary Calcium Score and Prediction of All-Cause Mortality in Diabetes
Open Access
- 20 April 2011
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 34 (5), 1219-1224
- https://doi.org/10.2337/dc11-0008
Abstract
OBJECTIVE In diabetes, it remains unclear whether the coronary artery calcium (CAC) score provides additional information about total mortality risk beyond traditional risk factors. RESEARCH DESIGN AND METHODS A total of 1,051 participants, aged 34–86 years, in the Diabetes Heart Study (DHS) were followed for 7.4 years. Subjects were separated into five groups using baseline computed tomography scans and CAC scores (0–9, 10–99, 100–299, 300–999, and ≥1,000). Logistic regression was performed adjusting for age, sex, race, smoking, and LDL cholesterol to examine the association between CAC and all-cause mortality. Areas under the curve with and without CAC were compared. Natural splines using continuous measures of CAC were fitted to estimate the relationship between observed CAC and mortality risk. RESULTS A total of 17% (178 of 1,051) of participants died during the follow-up. In multivariate analysis, the odds ratios (95% CIs) for all-cause mortality, using CAC 0–9 as the reference group, were CAC 10–99: 1.40 (0.57–3.74); CAC 100–299: 2.87 (1.17–7.77); CAC 300–999: 3.04 (1.32–7.90); and CAC ≥1,000: 6.71 (3.09–16.87). The area under the curve without CAC was 0.68 (95% CI 0.66–0.70), and the area under the curve with CAC was 0.72 (0.70–0.74) (P = 0.0001). Using splines, the estimated risk (95% CI) of mortality for a CAC of 0 was 6.7% (4.6–9.7), and the risk increased nearly linearly, plateauing at CAC ≥1,000 (20.0% [15.7–25.2]). CONCLUSIONS In diabetes, CAC was shown to be an independent predictor of mortality. Participants with CAC (0–9) were at lower risk (0.9% annual mortality). The risk of mortality increased with increasing levels of CAC, plateauing at approximately CAC ≥1,000 (2.7% annual mortality). More research is warranted to determine the potential utility of CAC scans in diabetes.Keywords
This publication has 27 references indexed in Scilit:
- Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studiesThe Lancet, 2010
- Coronary Artery Calcification Compared With Carotid Intima-Media Thickness in the Prediction of Cardiovascular Disease IncidenceThe Multi-Ethnic Study of Atherosclerosis (MESA)Archives of Internal Medicine, 2008
- Effects of Intensive Glucose Lowering in Type 2 DiabetesNew England Journal of Medicine, 2008
- The prevalence of coronary arterycalcium among diabetic individuals without known coronary artery diseaseJournal of the American College of Cardiology, 2003
- Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)JAMA, 2001
- Increased Prevalence of Significant Coronary Artery Calcification in Patients With DiabetesDiabetes Care, 2001
- Cause of death in clinical researchJournal of the American College of Cardiology, 1999
- Diet-induced Diabetes Activates an Osteogenic Gene Regulatory Program in the Aortas of Low Density Lipoprotein Receptor-deficient MicePublished by Elsevier BV ,1998
- Medial Artery CalcificationArteriosclerosis, Thrombosis, and Vascular Biology, 1996
- Diabetes and cardiovascular disease. The Framingham studyJAMA, 1979