Coronary artery calcium and cardiovascular risk in diabetes

Abstract 

Measurement of coronary artery calcium score (CACS) by electron beam tomography has been shown to a powerful predictor of coronary heart disease events in asymptomatic non-diabetic subjects. In type 2 diabetes, measurement of CACS was found to be a powerful predictor of cardiovascular events which could enhance prediction provided by established risk models. 23% of type 2 diabetic subjects with low CACS were found to be at low risk for cardiovascular events. Moreover mortality was similar for type 2 diabetic and non-diabetic subjects with undetectable coronary artery calcification. Conversely type 2 diabetic subjects with high CACS were identified who were at high cardiovascular risk. Thus not all those with type 2 diabetes are at similar cardiovascular risk. Measurement of CACS enables cardiovascular risk in type 2 diabetes to be stratified so that the level of preventive therapy could be reduced in some and intensified in others. Although prospective data for the power of CACS to predict CHD events in type 1 diabetes are lacking, measurement of CACS could help in deciding on preventive therapy in type 1 diabetes.

Abbreviations: CACS, coronary artery calcium score, CHD, coronary heart disease, CVD, cardiovascular disease, DCCT, Diabetes Control and Complication Study, EDC, Pittsburgh Epidemiology of Diabetes Complications Study, EBCT, electron beam computed tomography, EDIC, Epidemiology of Diabetes Interventions and Complications, HOMA-IR, homeostasis model assessment insulin resistance, MESA, Multi-Ethnic Study of Atherosclerosis, PREDICT, prospective evaluation of diabetic ischaemic heart disease by computed tomography

Keywords: Coronary artery calcium score, Coronary heart disease, Electron beam computed tomography, Prediction of coronary heart disease events