【論文摘要】Coronary Artery Calcium Score Predict Mid-term Cardiovascular Outcome in Asymptomatic Patients with Type 2 Diabetes

Meng-Huan Lei ； Wei-Cheng Chen ； Chao-Chin Chen ； Yu-Cheng Hsu

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 224-224

https://doi.org/10.6907/SCJ.201909/SP_1(2).0187

摘要

Background/Synopsis: Cardiovascular disease is the cause of death in 65-75% of diabetic patients. Diabetic patients have more extensive atherosclerosis with a higher prevalence of multi-vessel coronary artery disease (CAD), frequent silent myocardial ischemia and infarction with a poorer prognosis as compared with non-diabetic counterparts. But diabetes is no longer viewed as coronary risk-equivalent, and heterogeneity of cardiovascular risk exists, suggesting further risk stratification mandatory before universal treatment. Objectives/Purpose: The aim of this study was to determine the prevalence and clinical predictors of coronary artery calcium (CAC) score in uncomplicated type 2 diabetes (T2DM), and evaluate CAC score as a predictor of cardiovascular outcome in asymptomatic Taiwanese T2DM cohorts. Methods/Results: This study recruited 2162 T2DM patients (age 40 to 80 years, mean 64.5±9.3, 48% male) without prior cardiovascular disease from Yi-Lan Diabetes Shared Care Network over a 12-months period. Medical history including traditional cardiovascular risk factors (hypertension, hypercholesterolemia, smoking, family history of premature CAD, macro/microalbuminuria), duration of DM, treatment history, and body mass index were recorded. Coronary artery calcium (CAC) imaging was performed using an 16 or 64-sliced multi-detector computerized tomography scanner. Cardiovascular outcome were assessed completely in 1928 patients after 8.4 years' follow-up. Ordered logistic regression analysis was applied to identify clinical predictors of subclinical atherosclerosis (CAC). Cox proportional hazards regression was used to calculate hazard ratios (HRs) for all-cause mortality and incident cardiovascular risk, separated by each CAC category. 96.8% of patients had one or more risk factors. The distribution of CAC scores were 〞0〞 in 24.2%, 〞1-100〞 in 41.5%, 〞101-400〞 in 20.3%, 〞＞400〞 in 14.0% of patients. The multivariable predictors of increased CAC include age(year)(OR 1.07, 95% CI 1.06-1.08), male gender(OR 1.82,95% CI 1.54-2.17), duration(year) of DM(OR 1.07, 95% CI 1.05-1.09) and multiple risk factors(OR 1.94, 95% CI 1.28-2.95). There was no difference in the severity of CAC in patients with 2 or less risk factors. Increasing severity of CAC category was associated with higher all-cause or cardiac mortality and incident cardiovascular events by Kaplan-Meier analyses. The HRs for cardiac death, coronary revascularization or major cardiac events in 〞CAC＞400〞 vs 〞CAC=0〞 were 8.67, 10.83, 10.52, respectively (p＜0.001). Conclusion: CAC scoring provide better prognostication of adverse cardiovascular events than traditional risk factors in asymptomatic T2DM patients, and may identify high-risk subset for enhancing primary prevention.