Potential Implications of Coronary Artery Calcium Testing for Guiding Aspirin Use Among Asymptomatic Individuals With Diabetes

• Type of Material: Article
• Authors: Michael Gordon Silverman, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease; Michael J. Blaha, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease; Matthew J. Budoff, Harbor UCLA; Juan J. Rivera, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease; Paolo Raggi, Emory University; Leslee J Shaw, Emory University; Daniel Berman, Cedars-Sinai Medical Center; Tracy Callister, Tennessee Heart and Vascular Center; John A. Rumberger, Princeton Longevity Center; Jamal S. Rana, Cedars-Sinai Medical Center; Roger S. Blumenthal, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease; Khurram Nasir, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease
• Language: English
• Date: 2012-03-01
• Publisher: American Diabetes Association
• Publication Version: Final Published Version
• Copyright Statement: © 2012 by the American Diabetes Association.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.2337/dc11-1773
• Title of Journal or Parent Work: Diabetes Care
• ISSN: 0149-5992
• Volume: 35
• Issue: 3
• Start Page: 624
• End Page: 626
• Grant/Funding Information: This research was conducted without dedicated funding.
• Keywords: ENDOCRINOLOGY & METABOLISM; ALL-CAUSE MORTALITY; Science & Technology; Endocrinology & Metabolism; Life Sciences & Biomedicine; PREDICTION; CARDIOVASCULAR EVENTS
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, General

Abstract

OBJECTIVE - It is unclear whether coronary artery calcium (CAC) is effective for risk stratifying patients with diabetes in whom treatment decisions are uncertain. RESEARCH DESIGN AND METHODS - Of 44,052 asymptomatic individuals referred for CAC testing, we studied 2,384 individuals with diabetes. Subjects were followed for amean of 5.6 6 2.6 years for the end point of all-cause mortality. RESULTS - There were 162 deaths (6.8%) in the population. CAC was a strong predictor of mortality across age-groups (age < 50, 50-59, ≥60), sex, and risk factor burden (0 vs. ≥1 additional risk factor). In individuals without a clear indication for aspirin per current guidelines, CAC stratified risk, identifying patients above and below the 10% risk threshold of presumed aspirin benefit. CONCLUSIONS - CAC can help risk stratify individuals with diabetes and may aid in selection of patients who may benefit from therapies such as low-dose aspirin for primary prevention.