CAC better predictor of CVD, mortality risk in female diabetics, claims study

It is an accepted fact that people with diabetes are more likely to have coronary artery calcium (CAC) on computed tomography (CT) scanning, a marker of subclinical atherosclerosis, as well as greater levels of CAC. A substantial proportion of adults with diabetes have CAC = 0 associated with a long-term event-free risk, identifying great heterogeneity in risk according to the level of CAC and indicating diabetes is not necessarily a CHD risk equivalent.

Diabetes has been reported to be a stronger risk factor for CVD events among women compared with men; however, whether this remains the case in contemporary U.S. cohorts and what might explain such differences is uncertain.

With such inconsistencies in the previous studies in mind, Nathan D. Wong et al ,sought to undertake the study to compare the relation of CAC in women versus men with diabetes for total, CVD, and CHD mortality.

Study population included women and men aged >18 years from the CAC Consortium, a prospective cohort study of 66,636 asymptomatic adults who received clinically indicated CAC scans from 2004 to 2014 at four U.S. clinical sites. Diabetes was reported by physician diagnosis or self-report by the participant taking hypoglycemic therapy.

The primary outcome of the CAC Consortium was cause-specific mortality, with the first-order categorization into CVD mortality (inclusive of CHD, stroke, heart failure, and other cardiovascular mortality) and non-CVD mortality.

The key findings were as follows.

• Among 4,503 adults with diabetes (32.5% women) aged 21–93 years, 61.2% of women and 80.4% of men had CAC >0.
• Total, CVD, and CHD mortality rates were directly related to CAC; women had higher total and CVD death rates than men when CAC >100.
• Age- and risk factor-adjusted hazard ratios (HRs) per log unit CAC were higher among women versus men for total and CVD mortality, but were similar for CHD mortality (1.53 and 1.48).
• For CVD mortality, HRs with CAC scores of 101–400 and >400 were 3.67 and 6.27, respectively, for women and 1.63 and 3.48, respectively, for men.

"Our results suggest CAC screening in those with diabetes may be able to discriminate risk better in women compared with men, given the greater differences in absolute risk identified across CAC categories; however, it should be noted that moderate-significant levels of CAC (scores of >100) were also less common in women compared with men with diabetes (32% vs. 50%, respectively, in our sample). Nevertheless, this still represents a high proportion of women with diabetes at increased risk for CVD or all-cause mortality" the team concluded.

Primary source: Diabetes Care.

For the full article click on the link: .https://doi.org/10.2337/dc20-0166