Abstract 8165: The Association of Vascular Calcification and All Cause Mortality in Diabetes: Diabetes Heart Study
Background Coronary artery calcium (CAC), carotid artery calcium (CAAC), and abdominal aorta calcium (AAC) are noninvasive measures of atherosclerosis that predict mortality and are increasingly being utilized in risk prediction models. In a prior study we demonstrated that CAC is a powerful independent factor for mortality in type 2 diabetes affected subjects with odds of death six fold higher in CAC greater than thousand compared to CAC lower than ten. The objective of the current study was to determine which vascular bed is a better predictor of mortality in diabetes.
Methods A total of 854 participants, ages 39-86, with complete data on diabetes, vascular imaging and covariates in the Diabetes Heart Study (DHS) were followed for an average of 7.4 years. Atherosclerosis imaging was performed utilizing fast-gated helical computed tomography scan at baseline to obtain measures of coronary, carotid, and abdominal aorta Agatston calcium scores. Seven-year risk estimates for all-cause mortality were obtained using logistic regression models adjusted for age, gender, smoking, systolic blood pressure, antihypertensive medication use, total and high-density lipoprotein cholesterol, and race/ethnicity including log transformed (CAC+1), (CAAC+1), and (AAC+1).
Results Overall, 15% (129/854) of participants died during follow-up. Coronary artery calcium was associated more strongly than either carotid or abdominal calcium with mortality. After adjusting for potential confounders, and each other (CAC, CAAC, and AAC), the odds ratio of all-cause mortality increased 2.08 fold (95% CI, 1.46-3.01) for each 1-standard deviation (SD) increment of log transformed CAC score, 1.38 fold (95% CI, 1.02-1.89) for each 1-SD increment of log CAAC, and 0.9 fold (95% CI, 0.60-1.40) for each 1-SD increment of log AAC. A receiver operating characteristic curve analysis also suggested that CAC score was a better predictor of mortality than was CAAC and AAC, with areas under the curve of 0.77, 0.76, and 0.75, respectively.
Conclusion Atherosclerosis imaging is becoming widely available and is now utilized to predict future risk for clinical events. This study found that CAC score is a better predictor of mortality than carotid or abdominal aorta vascular beds in diabetes.
- © 2011 by American Heart Association, Inc.