Abstract 3780: Impact of Subclinical Atherosclerosis on Coronary Heart Disease Events in Persons with Metabolic Syndrome and Diabetes: the Multiethnic Study of Atherosclerosis
Background: Persons with versus without metabolic syndrome (MetS) and diabetes (DM) are more likely to have subclinical atherosclerosis. We examined whether screening for atherosclerosis in these groups adds to coronary heart disease (CHD) risk prediction.
Methods: In persons with and without MetS (defined by updated National Cholesterol Education Program/ NHLBI criteria) and DM enrolled in the Multiethnic Study of Atherosclerosis (MESA), a longitudinal study of persons free of cardiovascular disease at baseline, we studied the value of coronary artery calcium (CAC) and carotid intimal medial thickness (CIMT) in predicting CHD. We compared in each group the cumulative probability of hard (myocardial infarction and CHD death) CHD events occuring over a mean ( ± SD) follow-up time of 2.8 ± 0.9 years by CAC score group (0, 1–99, 100 –399, and 400+) and by common CIMT quartiles.
Results: Among 6,814 persons aged 45– 84, 1,996 (29%) had MetS and 1,018 (15%) had DM. Incident CHD events (% of subjects) across CAC score groups (0 to ≥ 400) ranged from 0.19% to 3.4% (p<0.0001) in those without MetS or DM, 0.22% to 2.9% (p<0.0001) in those with MetS, and 0.51% to 3.5% (p=0.06) in those with DM, and across common CIMT quartiles (1st to 4th) were 0.5% to 1.9% (p=0.002), 0.7% to 1.2% (p=0.06), and 0.6% to 2.7% (p=0.39), respectively. Multivariable Cox regression hazard ratios (HRs) and 95% confidence intervals (CI) for hard CHD events according to CAC and CIMT category, adjusted for Framingham risk score (FRS) and ethnicity are presented in the table⇓ below. Increasing CAC scores consistently predicted CHD events in persons with and without MetS or DM, independently of FRS. Neither common CIMT quartiles, nor internal CIMT (results not shown) independently predicted CHD events.
Conclusion: While CAC screening may improve CHD risk prediction in persons with MetS or DM over traditional risk assessment, CIMT assessment may not be useful in these groups for improving CHD risk prediction.