Coronary Calcium Helps Stratify 10-Year Cardiac Risk in Diabetes
November 24, 2017
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IRVINE, CA — Coronary artery calcium (CAC) scores may be better at predicting the risk of a cardiovascular disease (CVD) event in patients with type 2 diabetes than traditional scores such as Framingham, even in those who’ve had diabetes for 10 years, researchers report.
This conclusion is based on a new analysis of participants in the Multi-Ethnic Study of Atherosclerosis (MESA) published online in JAMA Cardiology by Dr Shaista Malik (University of California, Irvine) and colleagues.
“When we consider how we want to treat a person with type 2 diabetes, how aggressive to be, most of the guidelines . . . consider having type 2 diabetes to be equivalent to having already had a heart attack,” Dr Malik told theheart.org | Medscape Cardiology.
However, the new findings indicate that people with diabetes or metabolic syndrome “are a rather heterogeneous group,” she stressed.
They suggest that “diabetes in particular may not be a coronary artery disease equivalent, and we should see whether a patient could benefit from additional screening such as a coronary calcium score to improve personalization of therapy.”
Asked for his thoughts, Dr Donald W Bowden (Wake Forest School of Medicine, Winston-Salem, NC), who was not involved in the study, told theheart.org | Medscape Cardiology that these new data add “to an extensive literature documenting the utility of CAC imaging to improve prediction and aid treatment of CVD in both people with and without diabetes.”
“It shows that inferences from shorter-term follow-up studies remain compelling over long periods,” he said in an email.
Moreover, this also demonstrates that “CAC reclassifies a significant percentage of [diabetes] patients,” he noted, pointing out that when CAC scores were compared with the Framingham risk or other scores, almost half the patients with diabetes were reclassified to a higher or lower CVD risk group.
Malik said that for patients with diabetes “the general thinking has been . . . they probably are going to have coronary calcium, so further risk stratification is not going to be more predictive. But what we’re showing is—even in those with diabetes—getting information on how calcified their coronary arteries are is helpful in distinguishing those at lower risk from those at higher risk.”
Low CAC Score Can Be Considered “Warranty” for 10 Years in Diabetes
Malik and colleagues examined data from the MESA cohort of 6814 men and women aged 45 to 84 years without known CVD. Participants were ethnically diverse—white (38.5%), African American (27.5%), Hispanic (22%), and Chinese (12%)—and were enrolled in six US communities from July 2000 through August 2002.