Epidemiology and Prognostic Implications of Coronary Artery Calcium in Asymptomatic Individuals With Prediabetes
abstract
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Access this abstract nowOBJECTIVE
To describe the epidemiology and prognostic value of coronary artery calcium (CAC) in individuals with prediabetes.
RESEARCH DESIGN AND METHODS
We pooled participants free of clinical atherosclerotic cardiovascular disease (ASCVD) from four prospective cohorts: the Multi-Ethnic Study of Atherosclerosis, Heinz Nixdorf Recall Study, Framingham Heart Study, and Jackson Heart Study. Two definitions were used for prediabetes: inclusive (fasting plasma glucose [FPG] ≥100 to <126 mg/dL and hemoglobin A1c [HbA1c] ≥5.7% to <6.5%, if available, and no glucose-lowering medications) and restrictive (FPG ≥110 to <126 mg/dL and HbA1c ≥5.7% to <6.5%, if available, among participants not taking glucose-lowering medications).
RESULTS
The study included 13,376 participants (mean age 58 years; 54% women; 57% White; 27% Black). The proportions with CAC ≥100 were 17%, 22%, and 37% in those with euglycemia, prediabetes, and diabetes, respectively. Over a median (25th-75th percentile) follow-up time of 14.6 (interquartile range 7.8-16.4) years, individuals with prediabetes and CAC ≥100 had a higher unadjusted 10-year incidence of ASCVD (13.4%) than the overall group of those with diabetes (10.6%). In adjusted analyses, using the inclusive definition of prediabetes, compared with euglycemia, the hazard ratios (HRs) for ASCVD were 0.79 (95% CI 0.62, 1.01) for prediabetes and CAC 0, 0.70 (0.54, 0.89) for prediabetes and CAC 1-99, 1.54 (1.27, 1.88) for prediabetes and CAC ≥100, and 1.64 (1.39, 1.93) for diabetes. Using the restrictive definition, the HR for ASCVD was 1.63 (1.29, 2.06) for prediabetes and CAC ≥100.
CONCLUSIONS
CAC ≥100 is frequent among individuals with prediabetes and identifies a high ASCVD risk subgroup in which the adjusted ASCVD risk is similar to that in individuals with diabetes.
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Additional Info
Epidemiology and Prognostic Implications of Coronary Artery Calcium in Asymptomatic Individuals With Prediabetes: A Multicohort Study
Diabetes Care 2024 Apr 01;47(4)698-706, M Al Rifai, MH Al-Mallah, MJ Blaha, J Patel, JW McEvoy, K Nasir, I Shahid, KV Patel, G Sharma, J Marrugat, H Tizon-Marcos, R Erbel, A Stang, KH Jöckel, N Lehmann, S Schramm, B Schmidt, RS Blumenthal, SS Virani, V Nambi, M Cainzos-AchiricaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The authors evaluated the utility of coronary artery calcium (CAC) in the setting of prediabetes. The authors pooled participants free of clinical atherosclerotic CVD (ASCVD) from four prospective cohorts: 1) the Multi-Ethnic Study of Atherosclerosis; 2) the Heinz Nixdorf Recall Study; 3) the Framingham Heart Study; and 4) the Jackson Heart Study. The study included 13,376 participants who were followed for events over a median follow-up time of 14.6 years. The investigators found that a CAC score ≥100 is both common in individuals with prediabetes and identifies a high ASCVD–risk subgroup, in whom the risk is similar to that of those with diabetes.
Prediabetes is not a recognized risk factor, and the associated risk is heterogenous. This study demonstrates that prediabetes, in the setting of a CAC score ≥100, has a hazard ratio for ASCVD of 1.63 compared with euglycemia, the same cardiovascular risk as the patients with overt diabetes (HR, 1.64). Thus, by use of a simple noninvasive test (CAC), one can identify a high ASCVD–risk group. Accurate assessment of cardiovascular risk in this heterogenous cohort of patients with prediabetes will allow for better targeting of therapies and more aggressive treatment of cardiovascular risk factors.