Abstract 493: Compliance With Statin Therapy Improves Clinical Outcome in Diabetic and Matched Control Subjects Both With and Without Progression of Coronary Artery Calcification
Background: Progression of coronary artery calcium (CAC) is an excellent marker of coronary artery disease (CAD) which predicts all-cause mortality. This study evaluates the impact of statin therapy on the progression of CAC among diabetics (DM) and non-DM.
Methods: 296 asymptomatic DM and 300 matched controls (age 59 ±6 years, 29% female) underwent baseline and follow-up computed tomography within a 2 year interval. The controls were matched to the diabetic cohort with age, gender, CAD risk factors and baseline CAC. Compliance with statin vs. less intensive lipid reduction therapy in all groups was assessed. Baseline CAC, absolute annual changes in CAC (ΔCAC), percent of CAC progression (>15%/year), and the effect of statin therapy vs. less intensive lipid reduction therapy in non-DM and DM both with and without CAC progression were assessed. Mean follow-up was 4 ±2 years after the 2nd scan. Multivariable Cox proportional hazard regression analysis models were developed to predict all-cause mortality.
Results: ΔCAC was 34.3 ±4.8 in matched controls vs. 80.6 ±10 in DM (p = 0.0001). DM had more CAC progression than the matched controls (62.5% vs. 33.5%, p = 0.0001). Risk adjusted relative risk of all cause mortality in statin use vs. less intensive lipid lowering therapy were 0.29 (95% CI 0.13– 0.56, p = 0.001) in non-DM with non-CAC progression, 0.51 (95% CI 0.21– 0.73, p = 0.001) in DM with non-CAC progression, 0.71 (95% CI 0.25– 0.91, p = 0.003) in non-DM with CAC progression as compared to the DM with CAC progression (Fig⇓).
Conclusions: Compliance with statin therapy is associated with improved clinical outcome proportionally from DM to non-DM and from CAC progression to non-CAC progression.