The American Diabetes Association 72nd Scientific Sessions:
Diabetes Heart Study: Which Measure of Atherosclerotic Plaque Best Predicts Cardiovascular Mortality?
Patients with type 2 diabetes are at an increased risk of cardiovascular disease and mortality. The researchers who presented the poster “The Association of Vascular Atherosclerotic Plaque and Cardiovascular Mortality in the Diabetes Heart Study”1 at the 72nd Scientific Sessions of the American Diabetes Association had previously done a study that determined that coronary artery calcium (CAC) is a strong predictor of all-cause mortality and cardiovascular mortality for type 2 diabetes patients.
This research built off that previous study. In it, the researchers measured atherosclerotic plaque at various points in the vascular system and compared the predictive value of those measurements for CVD mortality.
There were 854 subjects (ages 39-86) who had been part of the Diabetes Heart Study; they had full data of diabetes, imaging, and covariates. The researchers followed them for 7.4 years on average as part of this study.
At baseline, fast-gated helical CT scans were used for atherosclerotic imaging. This was to find the coronary, carotid, and abdominal aorta Agatston calcium scores. Using logistic regression models (adjusted for age, gender, race/ethnicity, systolic blood pressure, blood pressure medication use, smoking, and cholesterol measures), the 7-year risk estimate for CVD mortality was calculated.
During follow-up 68 of the patients died (8%).
Study Results on Atherosclerotic Plaque Measurements
Coronary artery calcium (CAC) was strongly associated with mortality—more strongly than either carotid artery calcium (CAAC) or abdominal aorta calcium (AAC).
Additionally, a receiver operating characteristic curve analysis also indicated that CAC was a strong CVD mortality predictor than CAAC or AAC; the area under the curve was 0.78, 0.77, and 0.77 (respectively).
Therefore, this study shows that CAC, when compared to carotid artery calcium and abdominal aorta calcium, is a better predictor of cardiovascular mortality in type 2 diabetes patients.