Cited by 392Cardiac Imaging and DiagnosticsDiabetes, Cardiovascular Risks, and LipoproteinsCardiovascular Function and Risk Factors

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Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy

Anand, Dhakshinamurthy Vijay, Lim, Eric, Hopkins, David, Corder, Roger, Shaw, Leslee J., Sharp, Patrick, Lipkin, David, Lahiri, Avijit·2006·European Heart Journal

DOI 10.1093/eurheartj/ehi808

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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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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
ORCID: Hopkins, David
Corder, Roger
Shaw, Leslee J.
Lahiri, Avijit
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
DOI: 10.1093/eurheartj/ehi808
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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Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy

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