Calcium Scores Predict Cardiovascular Events in Type 2 Diabetes: Presented at EAS

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Title: Calcium Scores Predict Cardiovascular Events in Type 2 Diabetes: Presented at EAS
URL: http://www.pslgroup.com/dg/2205E6.htm
Doctor's Guide
April 29, 2008

By Sara Freeman

ISTANBUL, Turkey -- April 28, 2008 -- Patients with type 2 diabetes who have high coronary artery calcification scores (CACS) are more likely than those with lower scores to experience a cardiovascular (CV) event such as a myocardial infarction, according to data from a prospective trial.

As many as 23% of patients with diabetes therefore may not need aggressive cardiovascular management, suggested the Prospective Evaluation of Diabetic Ischaemic Heart Disease by Computed Tomography (PREDICT) study investigators in a presentation here at the 77th European Atherosclerosis Society (EAS) Congress.

"Over the past 10 years we've learnt a lot about the relationship between cardiovascular disease and coronary artery calcification," said investigator Ian Godsland, MD, Wynn Reader in Human Metabolism, Imperial College London, London, United Kingdom. "But we think the PREDICT study is the first to evaluate the relationship between the two."

The PREDICT study involved 622 patients with type 2 diabetes without a history of CV disease who were recruited over a 3-year period starting in November 2000. Of these, 589 underwent electron beam computed tomography to assess CACS.

Patient acceptability of this diagnostic procedure is a consideration, and Dr. Godsland conceded that this may have been a factor that resulted in not all recruited patients undergoing the investigative procedure.

After a median follow-up of 4 years, 66 primary endpoints of a first CV or stroke event had occurred; these included 14 myocardial infarctions (half proved to be fatal) and 10 strokes (2 fatal). In addition, there were 36 new cases of nonfatal coronary artery disease, 1 revascularisation procedure, and 5 cases of unstable angina or acute coronary syndromes.

There was a clear and significant association between CACS and events rates. A CACS of between 0 and 10 was taken as a reference point and hazard ratios worked out for CACS of 11 to 100, 101 to 400, 401 to 1000, and 1001 to 10,000. The respective hazard ratios for each of these scores were 5.4, 10.4, 11.9, and 19.7. A CACS of 0 to 10 indicates that there is <10% chance of CV disease, while a score of >400 means that there is a >90% chance of at least 1 coronary stenosis.

CACS remained an independent predictor of CV events even after multivariate analysis, Dr. Godsland said on April 27. The only other 2 independent predictors were systolic hypertension and insulin resistance, but the influence of CACS topped them both.

Furthermore, when CACS was considered in tandem with either the Framingham or UK Prospective Diabetes Study risk scores, the predictive ability of both increased.

"CACS is highly predictive of CV events in type 2 diabetes," said Dr. Godsland, adding that it helped identify a high-risk group of patients who may benefit from more intensive preventative therapies. Conversely, almost a quarter of patients were categorised as "low risk," and those patients may not need immediate intervention.

"CACS could become a powerful tool in evaluating CV risk in type 2 diabetes, but I think we have lot of cost/benefit analysis to do in order to answer that question," the author said.

[Presentation title: Prospective Evaluation of Coronary Artery Calcium in Predicting Cardiovascular Events in Asymptomatic Patients With Type 2 Diabetes: The PREDICT Study. Abstract WO6-OR3]

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