CAC burden tied to cardiovascular risk in diabetics: Study
USA: A recent study in the Journal of Diabetes and its Complications has shown coronary artery calcium (CAC) burden to be associated with atherosclerotic cardiovascular disease (ASCVD) risk in diabetes patients.
"CAC scoring reduces ASCVD risk and increases statin prescriptions in diabetes patients, potentially warranting routine assessment in this population," Sadeer Al-Kindi, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA, and colleagues wrote in their study.
In patients with diabetes, CAC scoring is not routinely performed based on an existing class I indication for statin therapy in these patients. However, in asymptomatic individuals with prediabetes and diabetes, CAC scoring may improve risk classification and prediction of cardiovascular events beyond the risk scores, warranting CAC assessment in this population.
The researchers conducted a prospective observational study in a large health system offering no-charge CAC scoring for primary prevention risk prediction with available measurement of glycosylated hemoglobin (HbA1c) between June 2015 and March 2019. The patients were divided according to no diabetes (HbA1c <5.7 %), prediabetes (HbA1c 5.7 %–6.4 %), or diabetes (HbA1c ≥ 6.5 % or charted history). They were then followed for major adverse cardiovascular events [myocardial infarction, stroke, death (MACE), or coronary revascularization]. Measurement of health history, patient characteristics, statin prescription rates, and laboratory data was done at baseline and at one year following CAC scoring.
During the study period, a total of 12,194 subjects with available HbA1c underwent CAC scoring (6462 diabetes, 2062 prediabetes, and 3670 without diabetes).
Based on the study, the researchers found the following:
- At a median follow-up of 1.2 years, there were 458 MACE events (71 patients without diabetes, 66 patients with prediabetes, and 321 patients with diabetes).
- Among patients with diabetes or prediabetes, increased CAC was associated with MACE (HR 1.38) and MACE or revascularization (HR 1.70).
- In patients with diabetes, CAC category was associated with greater statin initiation (89.6 % for CAC≥400 vs 60.1 % for CAC = 0) and high-intensity statin initiation (42.2 % for CAC≥400 vs 16.8 % for CAC = 0) at one-year post CAC scoring.
- Patients with diabetes had greater reductions in systolic blood pressure, LDL-C, total cholesterol, and triglycerides from baseline with a CAC ≥400 compared to a lower CAC category.
"Our findings showed that coronary artery calcium burden correlates with cardiovascular risk in diabetics," wrote the authors. "In our real-world study, post calcium scoring statin use increased in diabetics."
"Diabetics with high CAC had a greater reduction in LDL-C post-CAC scoring."
Reference:
The study titled, "Relation of coronary calcium scoring with cardiovascular events in patients with diabetes: The CLARIFY Registry," was published in the Journal of Diabetes and its Complications.
DOI: https://doi.org/10.1016/j.jdiacomp.2022.108269
