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. 2011 May;34(5):1219-24.
doi: 10.2337/dc11-0008. Epub 2011 Mar 11.

Coronary calcium score and prediction of all-cause mortality in diabetes: the diabetes heart study

Subhashish Agarwal  1 , Timothy Morgan, David M Herrington, Jianzhao Xu, Amanda J Cox, Barry I Freedman, J Jeffrey Carr, Donald W Bowden
Affiliations

Coronary calcium score and prediction of all-cause mortality in diabetes: the diabetes heart study

Subhashish Agarwal et al. Diabetes Care. 2011 May.

Abstract

Objective: In diabetes, it remains unclear whether the coronary artery calcium (CAC) score provides additional information about total mortality risk beyond traditional risk factors.

Research design and methods: A total of 1,051 participants, aged 34-86 years, in the Diabetes Heart Study (DHS) were followed for 7.4 years. Subjects were separated into five groups using baseline computed tomography scans and CAC scores (0-9, 10-99, 100-299, 300-999, and ≥1,000). Logistic regression was performed adjusting for age, sex, race, smoking, and LDL cholesterol to examine the association between CAC and all-cause mortality. Areas under the curve with and without CAC were compared. Natural splines using continuous measures of CAC were fitted to estimate the relationship between observed CAC and mortality risk.

Results: A total of 17% (178 of 1,051) of participants died during the follow-up. In multivariate analysis, the odds ratios (95% CIs) for all-cause mortality, using CAC 0-9 as the reference group, were CAC 10-99: 1.40 (0.57-3.74); CAC 100-299: 2.87 (1.17-7.77); CAC 300-999: 3.04 (1.32-7.90); and CAC ≥ 1,000: 6.71 (3.09-16.87). The area under the curve without CAC was 0.68 (95% CI 0.66-0.70), and the area under the curve with CAC was 0.72 (0.70-0.74) (P = 0.0001). Using splines, the estimated risk (95% CI) of mortality for a CAC of 0 was 6.7% (4.6-9.7), and the risk increased nearly linearly, plateauing at CAC ≥ 1,000 (20.0% [15.7-25.2]).

Conclusions: In diabetes, CAC was shown to be an independent predictor of mortality. Participants with CAC (0-9) were at lower risk (0.9% annual mortality). The risk of mortality increased with increasing levels of CAC, plateauing at approximately CAC ≥ 1,000 (2.7% annual mortality). More research is warranted to determine the potential utility of CAC scans in diabetes.

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Figures

Figure 1
Figure 1
Subjects were separated into five groups based on CAC score derived from baseline CT scans, CAC (0-9, 10-99, 100-299, 300-999, and ≥1,000). CAC ORs for all-cause mortality for higher CAC scores in comparison to CAC score <10. Models adjusted for age, sex, race, smoking, and LDL cholesterol. ORs for all-cause mortality with higher CAC scores in the DHS cohort compared with CAC scores <10 in a full model.
Figure 2
Figure 2
Spline regression estimating probability of all-cause mortality and continuous coronary calcium score: the DHS.
See this image and copyright information in PMC

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