Abstract 4136: Incidence and Progression of Coronary Calcium Associated with Metabolic Syndrome and Diabetes in the Multiethnic Study of Atherosclerosis
Background: Persons with metabolic syndrome (MetS) or diabetes mellitus (DM) have greater subclinical atherosclerosis as evidenced by coronary artery calcium (CAC). The comparative progression of CAC among these groups has not been investigated.
Methods: We examined in the Multiethnic Study of Atherosclerosis (MESA), a prospective study of African-American, Asian, Caucasian, and Hispanic adults aged 45– 84 free of cardiovascular disease at baseline whether progression of CAC is greater in those with MetS or DM. 5,570 subjects (53% female, mean age 61.7 ± 10.1 years) received baseline (Exam 1) and follow-up cardiac CT (electron beam or multidetector) scans (at Exam 2 or 3) after a mean of 2.4 years. MetS was identified in 29% (n=1,598) of subjects based on updated National Cholesterol Education Program criteria. DM was defined in 14% (n=781) by self-report, fasting glucose ≥126 mg/dl, or on medication. Relative risk (RR) regression, adjusted for age, gender, follow-up time (between scans), ethnicity, and non-MetS risk factors compared the
development of CAC (among those w/o CAC at baseline) and
progression of CAC (defined as the change in CAC score from baseline to follow-up) (also adjusted for baseline CAC) among those with MetS or DM compared to neither condition.
Results: Among those without MetS/DM, MetS (w/o DM), and DM, the incidence of CAC among those initially free of CAC at baseline was 12%, 21%, and 24%, respectively (p<0.001) and progression of CAC (score change >0) occurred in 44%, 56%, and 64%, respectively (p<0.001). Compared to those w/o MetS/DM, the adjusted incidence (from RR regression) of new CAC was 9% and 12% greater and progression of CAC 10% and 18% more likely in those with MetS and DM, respectively (both p<0.001). Among those with CAC at baseline, for those without MetS/DM, MetS (w/o DM), and DM, mean baseline CAC scores were 108.1, 136.3, and 232.1, respectively (p<0.001 across groups) with adjusted changes in CAC of 89.6, 110.4, and 158.1 (p<0.01 to p<0.001 between each group), respectively.
Conclusions: Individuals with MetS have a higher and those with DM the highest incidence and absolute progression of CAC compared to individuals without MetS/DM. The relation of these findings to future cardiovascular events needs investigation.