Coronary Artery Calcium Score Compared with Cardio-Ankle Vascular Index in the Prediction of Cardiovascular Events in Asymptomatic Patients with Type 2 Diabetes

Chung, Sheng-Liang; Yang, Chulho; Chen, Chao-Chin; Hsu, Yu-Cheng; Lei, Meng‐Huan

doi:10.5551/jat.29926

Cited by 56 publications

(54 citation statements)

References 48 publications

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“…Although CAC score has a greater predictive value, CAVI seems also a useful method for the risk stratification of asymptomatic type 2 diabetic patients. Importantly, CAVI presents a range of advantages, such as being a low-cost procedure, is easy to be calculated and is not affected by blood pressure (37).…”

Section: Imaging Methods As Predictors For Cadmentioning

confidence: 99%

Screening and Risk Assessment of Coronary Artery Disease in Patients With Type 2 Diabetes: An Updated Review

Patsouras

Farmaki

Garmpi

et al. 2019

In Vivo

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Current literature indicates that there is a strong correlation between coronary artery disease (CAD) and type 2 diabetes. The arteriosclerotic progression occurs earlier and in a greater extent in the diabetic than in the non-diabetic population. In diabetic subjects, the detection of arterial disease does not always precede the development of an acute arterial incident. Herein, we reviewed studies published within the last 5 years in order to reveal the risk factors for coronary artery disease in patients with type 2 diabetes. In addition, we aimed to discuss how to diagnose in an early stage or even screen the presence of coronary artery disease in asymptomatic diabetic patients. Possible blood markers as predictors of CAD, which are mostly related to the lipidemic profile of subjects, are included in this review. Less invasive imaging methods than conventional coronary angiography, included in the article, are gradually used more in the diagnosis of CAD and show high effectiveness. Data from 23 articles with 22,350 patients having type 2 diabetes were summarized and presented descriptively. The rates of diabetes are increasing worldwide. The scientific community estimates that the number of people living with diabetes will rise dramatically the following years and will reach the number of 592 million by 2035 (1). Diabetes mellitus has a wide range of complications which includes both microvascular (renal, retinal, and neuropathic disease) and macrovascular complications [vascular disease and coronary artery disease (CAD)] (2). The main system affected by diabetes, causing death, is the cardiovascular one. As a result, patients suffering from diabetes are prone to more severe cardiovascular diseases and have greater complication rates than non-diabetic patients (3). Inflammatory elements, vascular smooth muscle cell proliferation and endothelial dysfunction, which characterize atherosclerosis, result in atherosclerotic plaque instability and progression (4-10). Atherosclerosis leading to CAD results in restriction of blood flow to the heart (11). It is common knowledge that the degree of stenosis varies among patients. Therefore, the clinical presentation of patients also varies from asymptomatic to stable angina and acute coronary syndrome (ACS), which includes unstable angina, stemi and non-stemi myocardial infraction (12). Diabetes is regarded as a CAD risk equivalent. This means that diabetic patients are at risk of having coronary events alike non-diabetic patients, who previously had one (13). Many factors contribute to the appearance of CAD in diabetes type 2 patients and only 25% of these are already known (14). As CAD constitutes a challenging task among practitioners, the aim of our review is to present the correlation between type 2 diabetes mellitus and CAD, according to current scientific reports, and to reveal possible 1039 This article is freely accessible online.

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Section: Imaging Methods As Predictors For Cadmentioning

confidence: 99%

Screening and Risk Assessment of Coronary Artery Disease in Patients With Type 2 Diabetes: An Updated Review

Patsouras

Farmaki

Garmpi

et al. 2019

In Vivo

View full text Add to dashboard Cite

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“…In the clinical setting, the coronary artery calcium score, the cardio-ankle vascular index, and pulse wave velocity are screening tools to detect coronary artery calcification and arterial sclerosis 13, 14) . Clinical factors associated with arterial stenosis (AS) are similar to risk factors for VC 15) .…”

Section: Introductionmentioning

confidence: 99%

Calcium Overload Accelerates Phosphate-Induced Vascular Calcification Via Pit-1, but not the Calcium-Sensing Receptor

Masumoto

Sonou

Ohya

et al. 2017

JAT

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Aim: Vascular calcification (VC) is a risk factor of cardiovascular and all-cause mortality in patients with chronic kidney disease (CKD). CKD–mineral and bone metabolism disorder is an important problem in patients with renal failure. Abnormal levels of serum phosphate and calcium affect CKD–mineral and bone metabolism disorder and contribute to bone disease, VC, and cardiovascular disease. Hypercalcemia is a contributing factor in progression of VC in patients with CKD. However, the mechanisms of how calcium promotes intracellular calcification are still unclear. This study aimed to examine the mechanisms underlying calcium-induced calcification in a rat aortic tissue culture model.Methods: Aortic segments from 7-week-old male Sprague–Dawley rats were cultured in serum-supplemented medium for 10 days. We added high calcium (HiCa; calcium 3.0 mM) to high phosphate (HPi; phosphate 3.8 mM) medium to accelerate phosphate and calcium-induced VC. We used phosphonoformic acid and the calcimimetic R-568 to determine whether the mechanism of calcification involves Pit-1 or the calcium-sensing receptor.Results: Medial VC was significantly augmented by HPi+HiCa medium compared with HPi alone (300%, p < 0.05), and was associated with upregulation of Pit-1 protein. Pit-1 protein concentrations in HPi+HiCa medium were greater than those in HPi medium. Phosphonoformic acid completely negated the augmentation of medial VC induced by HPi+HiCa. R-568 had no additive direct effect on medial VC.Conclusion: These results indicated that exposure to HPi+HiCa accelerates medial VC, and this is mediated through Pit-1, not the calcium-sensing receptor.

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“…These levels seemed to be too high for the cutoff level of CAVI. Chung et al [9] showed that patients with CAVI > 9.0 had a greater incidence of cardiovascular events than those with CAVI ≤9.0 (HR 1.18, p = 0.049) in diabetes patients, and Sato et al [10] showed that higher CAVI (CAVI ≥10.09) had greater cardiovascular events in metabolic syndrome patients. Kubota et al [11] showed that high CAVI (CAVI ≥10) posed a higher risk of cardiovascular disease events than low CAVI (CAVI < 9) did, and thus further discussion about appropriate cutoff values for discriminating low and medium risk will be needed.…”

Section: Assessment Of the Cutoff Level In Cavimentioning

confidence: 99%

Comparative Assessment of Cutoffs for the Cardio-Ankle Vascular Index and Brachial-Ankle Pulse Wave Velocity in a Nationwide Registry: A Cardiovascular Prognostic Coupling Study

Kabutoya

Kario

2018

Pulse

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Pulse wave velocity (PWV) and cardio-ankle vascular index (CAVI) are measurements of arterial stiffness and are widely used as indices of arteriosclerosis. In Japan, brachial-ankle PWV (baPWV) is generally used to measure PWV, and while the reference value for this parameter is specified in Japanese guidelines for the noninvasive vascular function test, the CAVI reference value has not been standardized. We measured CAVI in 4,545 patients with at least one cardiovascular risk factor, and baPWV in 1,737 of these 4,545 patients on the same day as a part of an ongoing nationwide registry. The association between CAVI and baPWV was positive and significant (r = 0.50, p < 0.001). The CAVI corresponding to baPWV 14 m/s derived from the regression line was 8.303 and the CAVI corresponding to baPWV 18 m/s was 9.059. The percentages of patients with low risk (CAVI < 8.303), medium risk (CAVI 8.303–9.058) and high risk (CAVI ≥9.059) were 35.0, 23.0, and 42.0% in 4,545 patients who underwent CAVI, respectively. The percentages of patients with baPWV < 14 m/s, baPWV 14–18 m/s and baPWV ≥18 m/s were 22.9, 47.3, and 29.8% in 1,737 patients who underwent both baPWV and CAVI, respectively. The average baPWV in low-risk patients (CAVI < 8.303, n = 642) was 14.97 ± 2.91 m/s, that in medium-risk patients (CAVI 8.303–9.058, n = 408) was 16.12 ± 2.80 m/s, and that in high-risk patients (CAVI ≥9.059, n = 687) was 18.40 ± 3.51 m/s. CAVI < 8.303 corresponded to a baPWV cutoff of 14 m/s, and CAVI ≥9.059 corresponded to a baPWV cutoff of 18 m/s. The results of this ongoing prospective study are expected to confirm the association between the CAVI reference value and cardiovascular events.

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Coronary Artery Calcium Score Compared with Cardio-Ankle Vascular Index in the Prediction of Cardiovascular Events in Asymptomatic Patients with Type 2 Diabetes

Cited by 56 publications

References 48 publications

Screening and Risk Assessment of Coronary Artery Disease in Patients With Type 2 Diabetes: An Updated Review

Screening and Risk Assessment of Coronary Artery Disease in Patients With Type 2 Diabetes: An Updated Review

Calcium Overload Accelerates Phosphate-Induced Vascular Calcification Via Pit-1, but not the Calcium-Sensing Receptor

Comparative Assessment of Cutoffs for the Cardio-Ankle Vascular Index and Brachial-Ankle Pulse Wave Velocity in a Nationwide Registry: A Cardiovascular Prognostic Coupling Study

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