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Author Notes:

Correspondence to. James K. Min, MD, FACC, Professor of Radiology and Medicine, 413 E. 69th Street, Suite 108, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY 10021, Phone: 646-962-6192, Fax: 646-962-0129, jkm2001@med.cornell.edu.

Dr. Truong reports grants from NIH, grants from DCRI, grants from ACRIN, grants from St. Jude Medical, outside the submitted work. Dr. Min is a consultant for Abbott Vascular, HeartFlow, Neograft Technologies, MyoKardia, and CardioDx. He is also on the scientific advisory board for Arineta, has ownership in MDDX and Autoplaq, and has a research agreement with GE Healthcare.

Relationship with Industry Policy: Dr. Min serves on the medical advisory boards of, Arineta and CardioDx. Dr. Min serves as a consultant to HeartFlow. Dr. Truong received grant support from St. Jude Medical, American College of Radiology Imaging Network, and Duke Clinical Research Institute.

All other authors have nothing to disclose.

Subjects:

Research Funding:

This study was supported in part by a grant from the National Institutes of Health (R01HL115150 and R01HL118019). This study was also funded, in part, by a generous gift from the Dalio Institute of Cardiovascular Imaging and the Michael Wolk Foundation. Dr. Truong was supported by the NIH (K23HL098370 and L30HL093896). Dr. Hyuk-Jae Chang was supported by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (MSIP) (2012027176).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Cardiac & Cardiovascular Systems
  • Radiology, Nuclear Medicine & Medical Imaging
  • diabetes mellitus
  • prognosis
  • mortality
  • coronary artery calcium
  • computed tomography
  • calcium score

Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality A 15-Year Follow-Up Study of 9715 Patients

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Journal Title:

Circulation: Cardiovascular Imaging

Volume:

Volume 9, Number 2

Publisher:

, Pages e003528-e003528

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background: Data regarding coronary artery calcification (CAC) prognosis in diabetic individuals are limited to 5-years follow-up. We investigated the long-term risk stratification of CAC among diabetics, compared to non-diabetic individuals. Methods and Results: 9715 asymptomatic individuals undergoing CAC scoring were followed for a median (IQR) of 14.7 (13.9–15.6) years The incidence density rate and hazard ratios (HR) with 95% confidence intervals (95%CI) were used to calculate all-cause mortality. Incremental prognostic utility of CAC was evaluated using the area under the receiver operator characteristic curve (AUC) and net reclassification improvement (NRI). Diabetics (54.7±10.8 years; 59.4% male) comprised 8.3% of the cohort (n=810), of which 188 (23.2%) died. For CAC=0, the rate of mortality was similar between diabetic and non-diabetic individuals for the first 5 years (p>0.05), with a non-linear increased risk of mortality for diabetics after 5 years (p<0.05). The adjusted risk of death for those in the highest (CAC>400) versus the lowest (CAC=0) category of CAC increased by a hazards of 4.64 (95%CI=3.74–5.76) and 3.41 (95%CI=2.22–5.22) for non-diabetic and diabetic individuals, respectively. The presence of CAC improved discrimination (AUC range: 0.73–0.74, P<0.01) and reclassification (category-free NRI range: 0.53–0.50, P<0.001) beyond conventional risk factors in non-diabetic and diabetic respectively. Conclusions: CAC=0 is associated with a favorable 5-year prognosis for asymptomatic diabetic and non-diabetic individuals. After 5 years, the risk of mortality increases significantly for diabetic individuals even in the presence of a baseline CAC=0.

Copyright information:

© 2016 American Heart Association, Inc.

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