Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study

R. S. Elkeles, I. F. Godsland, M. D. Feher, M. B. Rubens, M. Roughton, F. Nugara, S. E. Humphries, W. Richmond, M. D. Flather
2008 European Heart Journal  
total word count: 5590 2 ABSTRACT Aims: The PREDICT Study is a prospective cohort study designed to evaluate coronary artery calcification score (CACS) as a predictor of cardiovascular events in Type 2 diabetes (T2DM). Methods and Results : 589 patients with no history of cardiovascular disease and with established T2DM had CACS measured, as well as risk factors, including plasma lipoprotein, apolipoprotein, homocysteine and C-reactive protein concentrations, homeostasis model assessment
more » ... l assessment insulin resistance (HOMA-IR) and urine albumin creatinine ratio. Participants were followed for a median of 4 years and first coronary heart disease (CHD) and stroke events were identified as primary endpoints. There were 66 first cardiovascular events (including 10 strokes). CACS was a highly significant, independent predictor of events (p<0.001), with a doubling in CACS being associated with a 32% increase in risk of events (29% after adjustment). Hazard ratios relative to CACS in the range 0-10 Agatston units (AU) were: CACS 11-100AU, 5.4 (p=0.02); 101-400AU 10.5 (p=0.001); 401-1000AU, 11.9 (p=0.001) and >1000AU, 19.8 (p<0.001). Only HOMA-IR predicted primary endpoints independently of CACS (p=0.01). The areas under the ROC curve for UKPDS risk engine primary endpoint risk and for UKPDS risk plus CACS were 0.63 and 0.73, respectively (p=0.03). . Conclusion: Measurement of CACS is a powerful predictor of cardiovascular events in asymptomatic patients with type 2 diabetes and can further enhance prediction provided by established risk models. 3
doi:10.1093/eurheartj/ehn279 pmid:18573867 fatcat:slm4frbranbo5jxqx3fvfla4eu