Coronary Artery Calcification and Outcomes in Diabetic Patients with and without Chronic Kidney Disease

Abstract

Background/Aims: Presence and progression of coronary artery calcification (CAC) indicate severe atherosclerosis and predict cardiovascular events (CVE) in dialysis (ESRD patients) and nondialysis patients (CKD patients). This study aimed at evaluating the prevalence and progression of CAC and CVE in CKD patients with diabetes in whom atherosclerosis of coronary arteries is the leading cause of CVE. Methods: This was a retrospective study conducted in both out- and in-patients with chronic kidney disease, stage 2-5. CAC were assessed by the total calcium (TC) score. CT scans were performed at the entry and at the end of the study. Results: Patients (n = 341) were divided into nondiabetic (n = 281) and diabetic patients (n = 60). CAC prevalence and TC score were higher in diabetics and associated with age, diabetes mellitus and pulse pressure. Diabetics with CKD presented a higher percentage of CAC progression and CVE. Conclusion: Prevalence, extent, progression of CAC and CVE are higher in diabetics with concomitant CKD. These findings may promote a more aggressive protocol of screening and care in type 2 diabetics with concomitant CKD.

Utility of Traditional Circulating and Imaging-Based Cardiac Biomarkers in Patients with Predialysis CKD

“…Traditional factors explored included advanced age, white race, male sex, higher body mass index, and diabetes mellitus, in particular (46)(47)(48). A retrospective study of patients with stages 2-5 CKD with well controlled BP reported higher prevalence of CAC in patients with diabetes than in nondiabetic patients (77% versus 33%) ( Table 3) (46), and another study found faster progression in CAC among diabetic patients with CKD than in those without diabetes (48).…”

“…congestive heart failure; ACS, acute coronary syndrom; VA, Veterans Affairs; NT-pro-BNP, N-terminal B-type natriuretic peptide; 95% CI, 95% confidence interval; NYHA, New York Heart Association; aHR, adjusted hazard ratio; AUC, area under the curve; aRR, adjusted relative risk. limited follow-up, or ethnic homogeneity (Table 3) (46,47,50,51). A study of a predominantly Latino diabetic cohort reported that those in the highest compared with the lowest quartile of baseline CAC had a higher hazard of all-cause mortality at 39 months (47).…”

Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients

“…The pathophysiological mechanisms of this alteration are not fully known, but it has been established that the smooth muscle cells acquire osteoblast phenotype and favor extracellular deposit of calcium [1]. Factors such as hyperphosphatemia [2,3], hypercalcemia [4], secondary hyperparathyroidism [5], chronic inflammation [6,7], and diabetes seem to have an important role as promoters of this phenomenon [8,9]. …”

Differential Impact of Chronic Kidney Disease on Coronary Calcification and Atherosclerosis in Asymptomatic Individuals with or without Diabetes: Analysis from a Coronary Computed Tomographic Angiography Registry

“…Although it remains unclear whether impaired renal function is associated with coronary calcification independent of traditional cardiovascular risk factors, the development and progression of calcification seem to be linked to disrupted mineral metabolism in end-stage renal disease [18]. Conversely, other studies demonstrate that decreased renal function is not associated with greater plaque volume or growth, and luminal stenosis [19][20][21]. However, most studies included diabetic patients and did not distinguish diabetic from nondiabetic CKD.…”