CAC and CVD Events in DCCT/EDIC Trials

Study Questions:

Are coronary artery calcium (CAC) scores associated with subsequent cardiovascular disease (CVD) events in adults with type 1 diabetes?

Methods:

Data from the DCCT (Diabetes Control and Complications Trial) cohort were used for the present analysis. Participants all had type 1 diabetes and were followed in the EDIC (Epidemiology of Diabetes Interventions and Complications) study, the follow-up study of DCCT. At approximately 7 years of EDIC follow-up, computed tomography (CT) to measure coronary artery calcium (CAC) was offered to participants. For the present study, participants who had a CAC and were followed for 10-13 years were included. CAC was categorized as: 0, >0-100, >100-300, or >300 Agatston units. The primary outcome of interest was first major adverse cardiac event (MACE), including nonfatal myocardial infarction (MI), nonfatal stroke, or CV death.

Results:

A total of 1,205 DCCT/EDIC participants were included in this analysis. Mean age was 42.8 years. A total of 817 (70.7%) participants had a CAC score of 0, 221 (19.1%) had a CAC score >0-100, 65 (5.6%) had a CAC score >100-300, and 53 (4.6%) had a CAC score >300 Agatston units. Women had lower CAC scores than men. Increasing CAC scores were also associated with older age, longer duration of diabetes, smoking, higher systolic blood pressure (but not diastolic blood pressure), lower high-density lipoprotein cholesterol, higher triglycerides, and history of microalbuminuria. A total of 105 initial CVD events (8.5 per 1,000 patient-years) occurred during follow-up. Event rates among those with zero scores were very low for CVD (5.6 per 1,000 patient-years). Risk for CVD events increased for those with CAC scores from >0-100 (hazard ratio [HR], 1.54; 95% confidence interval [CI], 0.91-2.60), to CAC of >100-300 (HR, 4.05; 95% CI, 2.14-7.64) to CAC of >300 (HR, 4.73; 95% CI, 2.47-9.08) using those with a CAC score of 0 as the reference group and adjustment for site, gender, hemoglobin A1c, age, systolic blood pressure, antihypertensive medications, low-density lipoprotein, high-density lipoprotein, smoking, and family history of MI. A similar pattern was observed for MACE.

Conclusions:

The investigators concluded that CAC scores >100 Agatston units were associated with an increased risk of the subsequent occurrence of CVD and MACE among adults with type 1 diabetes.

Perspective:

These data suggest that CAC score can provide prognostic information among adults with type 1 diabetes.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Hypertriglyceridemia, Lipid Metabolism, Nonstatins, Computed Tomography, Nuclear Imaging, Smoking

Keywords: Antihypertensive Agents, Blood Pressure, Cholesterol, Coronary Artery Disease, Diabetes Mellitus, Type 1, Diagnostic Imaging, Hemoglobins, Myocardial Infarction, Plaque, Atherosclerotic, Primary Prevention, Smoking, Stroke, Tomography, Tomography, Emission-Computed, Triglycerides


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