Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy
Abstract
AIMS: To determine the prevalence and clinical predictors of subclinical atherosclerosis and myocardial ischaemia in uncomplicated type 2 diabetes and assess their relationship to short-term outcome. METHODS AND RESULTS: Established risk factors and coronary artery calcium (CAC) scores were prospectively measured in 510 asymptomatic type 2 diabetic subjects (mean age 53+/-8 years, 61% males) without prior cardiovascular disease. Myocardial perfusion scintigraphy (MPS) was performed in all subjects with CAC > 100 Agatston units (AU) (n=127), and a random sample of the remaining patients with CAC < or = 100 AU (n=53). Significant CAC (> 10 AU) was found in 46.3%. Twenty events occurred (two coronary deaths, nine non-fatal myocardial infarctions, three acute coronary syndromes, three non-haemorrhagic strokes, and three late revascularisations) during a median follow-up of 2.2 years (25th-75th percentile = 1.9-2.5 years). The age, systolic blood pressure, the duration of diabetes, United Kingdom Prospective Diabetes Study risk score, CAC score, and extent of myocardial perfusion abnormality were significant predictors of time to cardiovascular events in a univariable Cox proportional hazard model. No cardiac events or perfusion abnormalities occurred in subjects with CAC < or = 10 AU up until 2 years of follow-up. CAC and MPS findings were synergistic for the prediction of short-term cardiovascular events. CONCLUSION: Subclinical atherosclerosis, measured by CAC imaging, is superior to the established cardiovascular risk factors for predicting silent myocardial ischaemia and short-term outcome. Further studies evaluating the impact of CAC imaging on clinical outcomes and its cost effectiveness are warranted.
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An even higher prevalence of CAD was found in an autopsy study of asymptomatic decedents with diabetes.
“An even higher prevalence of CAD was found in an autopsy study of asymptomatic decedents with diabetes.385”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [385]
In people with diabetes, coronary artery calcium independently predicts future ASCVD events and outperforms the UKPDS and Framingham risk scores for risk prediction.
“In prospective studies, coronary artery calcium has been established as an independent predictor of future ASCVD events in people with diabetes and is consistently superior to both the UK Prospective Diabetes Study (UKPDS) risk engine and the Framingham Risk Score in predicting risk in this population (175 -177).”
From 10. Cardiovascular Disease and Risk Management: <i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [177]
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- Authors
- Anand, D. V., Lim, E., Hopkins, D., Corder, R., Shaw, L. J., Sharp, P., Lipkin, D., & Lahiri, A.
- Affiliations
- The Wellington Hospital (GB)
- King's College Hospital (GB)
- Queen Mary University of London (GB)
- Cedars-Sinai Medical Center (US)
- Northwick Park Hospital (GB)
- The Royal Free Hospital (GB)
- Corresponding author
- Anand, Dhakshinamurthy Vijay
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-02-23
- Volume
- 27
- Issue
- 6
- Pages
- 713-721
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2141506620
- Cited by
- 392
- References
- 35
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 14 · 2022: 7 · 2021: 12 · 2020: 11 · 2019: 17 · 2018: 14 · 2017: 13 · 2016: 19 · 2015: 32 · 2014: 28 · 2013: 25 · 2012: 25
- FWCI
- 27.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Bristol-Myers Squibb
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- type 2 diabetes, coronary artery calcium, myocardial perfusion scintigraphy, subclinical atherosclerosis, silent myocardial ischemia, cardiovascular risk stratification, cardiovascular events, Agatston score, asymptomatic diabetic patients
- MeSH terms
- Calcinosis, Coronary Vessels, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Radionuclide Imaging, Risk Factors, Myocardial Ischemia
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