Value of addition of coronary artery calcium to risk scores in the prediction of major cardiovascular events in patients with type 2 diabetes
Autor: | Walid Saliba, Razi Khoury, Barak Zafrir, David A. Halon, Elad Shemesh, Rachel Shay Li Widder |
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Rok vydání: | 2021 |
Předmět: |
Male
medicine.medical_specialty Computed Tomography Angiography Population Risk Assessment Coronary artery calcium Coronary artery disease chemistry.chemical_compound Diabetes mellitus Predictive Value of Tests Risk Factors Internal medicine Humans Diseases of the circulatory (Cardiovascular) system Medicine cardiovascular diseases Myocardial infarction Risk factor Vascular Calcification education Risk stratification Aged Retrospective Studies education.field_of_study Framingham Risk Score business.industry Hazard ratio Middle Aged Cardiovascular disease medicine.disease Coronary Vessels Diabetes Mellitus Type 2 chemistry Cardiovascular Diseases RC666-701 Cardiology Female Glycated hemoglobin Cardiology and Cardiovascular Medicine business Mace Research Article |
Zdroj: | BMC Cardiovascular Disorders BMC Cardiovascular Disorders, Vol 21, Iss 1, Pp 1-11 (2021) |
ISSN: | 1471-2261 |
Popis: | 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. |
Databáze: | OpenAIRE |
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