OBJECTIVES: The study was done to determine the interaction of coronary artery calcium and diabetes mellitus for prediction of all-cause death. BACKGROUND: Diabetes is a strong risk factor for coronary artery disease (CAD) and is associated with an elevated overall mortality. Electron beam tomography (EBT) provides information on the presence of subclinical atherosclerosis and may be useful for risk stratification. METHODS: We followed 10,377 asymptomatic individuals (903 diabetic patients) referred for EBT imaging. Primary end point was all-cause mortality, and the average follow-up was 5.0 +/- 3.5 years. Cox proportional hazard models, with and without adjustment for other risk factors, were developed to predict all-cause mortality. RESULTS: Patients with diabetes had a higher prevalence of hypertension and smoking (p < 0.001) and were older. The average coronary calcium score (CCS) for subjects with and for those without diabetes was 281 +/- 567 and 119 +/- 341, respectively (p < 0.0001). Overall, the death rate was 3.5% and 2.0% for subjects with and without diabetes (p < 0.0001). In a risk-factor-adjusted model, there was a significant interaction of CCS with diabetes (p < 0.00001), indicating that, for every increase in CCS, there was a greater increase in mortality for diabetic than for nondiabetic subjects. However, patients suffering from diabetes with no coronary artery calcium demonstrated a survival similar to that of individuals without diabetes and no detectable calcium (98.8% and 99.4%, respectively, p = 0.5). CONCLUSIONS: Mortality from all causes is increased in asymptomatic patients with diabetes in proportion to the screening CCS. Nonetheless, subjects without coronary artery calcium have a low short-term risk of death even in the presence of diabetes mellitus.
OBJECTIVES: The study was done to determine the interaction of coronary artery calcium and diabetes mellitus for prediction of all-cause death. BACKGROUND:Diabetes is a strong risk factor for coronary artery disease (CAD) and is associated with an elevated overall mortality. Electron beam tomography (EBT) provides information on the presence of subclinical atherosclerosis and may be useful for risk stratification. METHODS: We followed 10,377 asymptomatic individuals (903 diabeticpatients) referred for EBT imaging. Primary end point was all-cause mortality, and the average follow-up was 5.0 +/- 3.5 years. Cox proportional hazard models, with and without adjustment for other risk factors, were developed to predict all-cause mortality. RESULTS:Patients with diabetes had a higher prevalence of hypertension and smoking (p < 0.001) and were older. The average coronary calcium score (CCS) for subjects with and for those without diabetes was 281 +/- 567 and 119 +/- 341, respectively (p < 0.0001). Overall, the death rate was 3.5% and 2.0% for subjects with and without diabetes (p < 0.0001). In a risk-factor-adjusted model, there was a significant interaction of CCS with diabetes (p < 0.00001), indicating that, for every increase in CCS, there was a greater increase in mortality for diabetic than for nondiabetic subjects. However, patients suffering from diabetes with no coronary artery calcium demonstrated a survival similar to that of individuals without diabetes and no detectable calcium (98.8% and 99.4%, respectively, p = 0.5). CONCLUSIONS: Mortality from all causes is increased in asymptomatic patients with diabetes in proportion to the screening CCS. Nonetheless, subjects without coronary artery calcium have a low short-term risk of death even in the presence of diabetes mellitus.
Authors: Robert C Hendel; Brian G Abbott; Timothy M Bateman; Ron Blankstein; Dennis A Calnon; Jeffrey A Leppo; Jamshid Maddahi; Matthew M Schumaecker; Leslee J Shaw; R Parker Ward; David G Wolinsky Journal: J Nucl Cardiol Date: 2011-02 Impact factor: 5.952
Authors: Daniel S Berman; Matthew J Budoff; James K Min; Paolo Raggi; Alan Rozanski; Leslee Shaw; Prem Soman Journal: J Nucl Cardiol Date: 2015-08-12 Impact factor: 5.952
Authors: Bálint Szilveszter; Hesham Elzomor; Mihály Károlyi; Márton Kolossváry; Rolf Raaijmakers; Kálmán Benke; Csilla Celeng; Andrea Bartykowszki; Zsolt Bagyura; Árpád Lux; Béla Merkely; Pál Maurovich-Horvat Journal: Int J Cardiovasc Imaging Date: 2015-08-19 Impact factor: 2.357
Authors: Laura M Raffield; Subhashish Agarwal; Amanda J Cox; Fang-Chi Hsu; J Jeffrey Carr; Barry I Freedman; Jianzhao Xu; Donald W Bowden; Mara Z Vitolins Journal: Am J Clin Nutr Date: 2014-08-06 Impact factor: 7.045