Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes

Abstract Background The increased risk for cardiovascular events in diabetics is heterogeneous and contemporary clinical risk score calculators have limited predictive value. We therefore examined the additional value of coronary artery calcium score (CACS) in outcome prediction in type 2 diabetics...

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Autores principales:	Barak Zafrir, Walid Saliba, Rachel Shay Li Widder, Razi Khoury, Elad Shemesh, David A. Halon
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Diabetes mellitus Coronary artery calcium Risk stratification Cardiovascular disease Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/8031c86a67ad4f29bf722a7a99097134
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spelling	oai:doaj.org-article:8031c86a67ad4f29bf722a7a990971342021-11-14T12:07:30ZValue of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes10.1186/s12872-021-02352-41471-2261https://doaj.org/article/8031c86a67ad4f29bf722a7a990971342021-11-01T00:00:00Zhttps://doi.org/10.1186/s12872-021-02352-4https://doaj.org/toc/1471-2261Abstract Background The increased risk for cardiovascular events in diabetics is heterogeneous and contemporary clinical risk score calculators have limited predictive value. We therefore examined the additional value of coronary artery calcium score (CACS) in outcome prediction in type 2 diabetics without clinical coronary artery disease (CAD). Methods The study examined a population-based cohort of type 2 diabetics (n = 735) aged 55–74 years, recruited between 2006 and 2008. Patients had at least one additional risk factor and no history or symptoms of CAD. Risk assessment tools included Pooled Cohort Equations (PCE) and Multi-Ethnic Study of Atherosclerosis (MESA) 10-year risk score calculators and CACS. The occurrence of myocardial infarction (MI), stroke or cardiovascular death (MACE) was assessed over 10-years. Results Risk score calculators predicted MACE and MI and cardiovascular death individually but not stroke. Increasing levels of CACS predicted MACE and its components independently of clinical risk scores, glycated hemoglobin and other baseline variables: hazard ratio (95% confidence interval) 2.92 (1.06–7.86), 6.53 (2.47–17.29) and 8.3 (3.28–21) for CACS of 1–100, 101–300 and > 300 Agatston units respectively, compared to CACS = 0. Addition of CACS to PCE improved discrimination of MACE [AUC of PCE 0.615 (0.555–0.676) versus PCE + CACS 0.696 (0.642–0.749); p = 0.0024]. Coronary artery calcium was absent in 24% of the study population and was associated with very low event rates even in those with high estimated risk scores. Conclusions CACS in asymptomatic type 2 diabetics provides additional prognostic information beyond that obtained from clinical risk scores alone leading to better discrimination between risk categories.Barak ZafrirWalid SalibaRachel Shay Li WidderRazi KhouryElad ShemeshDavid A. HalonBMCarticleDiabetes mellitusCoronary artery calciumRisk stratificationCardiovascular diseaseDiseases of the circulatory (Cardiovascular) systemRC666-701ENBMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diabetes mellitus Coronary artery calcium Risk stratification Cardiovascular disease Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	Diabetes mellitus Coronary artery calcium Risk stratification Cardiovascular disease Diseases of the circulatory (Cardiovascular) system RC666-701 Barak Zafrir Walid Saliba Rachel Shay Li Widder Razi Khoury Elad Shemesh David A. Halon Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes
description	Abstract Background The increased risk for cardiovascular events in diabetics is heterogeneous and contemporary clinical risk score calculators have limited predictive value. We therefore examined the additional value of coronary artery calcium score (CACS) in outcome prediction in type 2 diabetics without clinical coronary artery disease (CAD). Methods The study examined a population-based cohort of type 2 diabetics (n = 735) aged 55–74 years, recruited between 2006 and 2008. Patients had at least one additional risk factor and no history or symptoms of CAD. Risk assessment tools included Pooled Cohort Equations (PCE) and Multi-Ethnic Study of Atherosclerosis (MESA) 10-year risk score calculators and CACS. The occurrence of myocardial infarction (MI), stroke or cardiovascular death (MACE) was assessed over 10-years. Results Risk score calculators predicted MACE and MI and cardiovascular death individually but not stroke. Increasing levels of CACS predicted MACE and its components independently of clinical risk scores, glycated hemoglobin and other baseline variables: hazard ratio (95% confidence interval) 2.92 (1.06–7.86), 6.53 (2.47–17.29) and 8.3 (3.28–21) for CACS of 1–100, 101–300 and > 300 Agatston units respectively, compared to CACS = 0. Addition of CACS to PCE improved discrimination of MACE [AUC of PCE 0.615 (0.555–0.676) versus PCE + CACS 0.696 (0.642–0.749); p = 0.0024]. Coronary artery calcium was absent in 24% of the study population and was associated with very low event rates even in those with high estimated risk scores. Conclusions CACS in asymptomatic type 2 diabetics provides additional prognostic information beyond that obtained from clinical risk scores alone leading to better discrimination between risk categories.
format	article
author	Barak Zafrir Walid Saliba Rachel Shay Li Widder Razi Khoury Elad Shemesh David A. Halon
author_facet	Barak Zafrir Walid Saliba Rachel Shay Li Widder Razi Khoury Elad Shemesh David A. Halon
author_sort	Barak Zafrir
title	Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes
title_short	Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes
title_full	Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes
title_fullStr	Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes
title_full_unstemmed	Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes
title_sort	value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes
publisher	BMC
publishDate	2021
url	https://doaj.org/article/8031c86a67ad4f29bf722a7a99097134
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Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes

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