Objective: The coronary calcium score (CCS) predicts cardiovascular disease risk in individuals with diabetes mellitus, and rate of progression of CCS is an additional and incremental marker of risk. 18 F-sodium fluoride positron emission tomography ( 18 F-NaF PET) detects early and active calcifications within the vasculature. We aimed to ascertain the relationship between 18 F-NaF PET activity and CCS progression in patients with diabetes mellitus. Approach and Results: We identified individuals between 50 and 80 years with diabetes mellitus and no history of clinical coronary artery disease. Those with a CCS ≥10 were invited to undergo 18 F-NaF PET scanning and then repeat CCS >2 years later. 18 F-NaF PET and CCS analysis were performed on a per-coronary and a per-patient level. We compared the proportion of CCS progressors in 18 F-NaF PET–positive versus 18 F-NaF PET–negative coronary arteries. Forty-one participants with 163 coronary arteries underwent follow-up CCS 2.8±0.5 years later. 18 F-NaF PET–positive coronary arteries (n=52) were more likely to be CCS progressors, compared with negative coronary arteries (n=111; 86.5% versus 52.3%, P <0.001). Adjusting for baseline CCS, 18 F-NaF PET–positive disease was an independent predictor of subsequent CCS progression (odds ratio, 2.92 [95% CI, 1.32–6.45], P =0.008). All subjects (100%, 15/15) with ≥2 18 F-NaF–positive coronary arteries progressed in CCS. Conclusions: In subjects with diabetes mellitus, 18 F-NaF PET positivity at baseline, independently predicted the progression of calcifications within the coronary arteries 2.8 years later. These findings suggest 18 F-NaF PET may be a promising technique for earlier identification of patients at higher risk of cardiovascular events.
Background Dietary vitamin K (K 1 and K 2 ) may reduce atherosclerotic cardiovascular disease (ASCVD) risk via several mechanisms. However, studies linking vitamin K intake with incident ASCVD are limited. We aimed to determine the relationship between dietary vitamin K intake and ASCVD hospitalizations. Methods and Results In this prospective cohort study, participants from the Danish Diet, Cancer, and Health Study, with no prior ASCVD, completed a food‐frequency questionnaire at baseline and were followed up for hospital admissions of ASCVD; ischemic heart disease, ischemic stroke, or peripheral artery disease. Intakes of vitamin K 1 and vitamin K 2 were estimated from the food‐frequency questionnaire, and their relationship with ASCVD hospitalizations was determined using Cox proportional hazards models. Among 53 372 Danish citizens with a median (interquartile range) age of 56 (52–60) years, 8726 individuals were hospitalized for any ASCVD during 21 (17–22) years of follow‐up. Compared with participants with the lowest vitamin K 1 intakes, participants with the highest intakes had a 21% lower risk of an ASCVD‐related hospitalization (hazard ratio, 0.79; 95% CI: 0.74–0.84), after multivariable adjustments for relevant demographic covariates. Likewise for vitamin K 2 , the risk of an ASCVD‐related hospitalization for participants with the highest intakes was 14% lower than participants with the lowest vitamin K 2 intake (hazard ratio, 0.86; 95% CI, 0.81–0.91). Conclusions Risk of ASCVD was inversely associated with diets high in vitamin K 1 or K 2 . The similar inverse associations with both vitamin K 1 and K 2 , despite very different dietary sources, highlight the potential importance of vitamin K for ASCVD prevention.
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