Coronary Computed Tomography (CT) Angiography as a Predictor of Cardiac and Noncardiac Vascular Events in Asymptomatic Type 2 Diabetics: A 7‐Year Population‐Based Cohort Study

Abstract

BackgroundType 2 diabetics are at increased risk for vascular events, but the value of further risk stratification for coronary heart disease (CHD) in asymptomatic subjects is unclear. We examined the added value of coronary computed tomography angiography over clinical risk scores (United Kingdom Prospective Diabetes Study), and coronary artery calcium in a population‐based cohort of asymptomatic type 2 diabetics.Methods and ResultsSubjects (n=630) underwent baseline clinical assessment and computed tomography angiography (64‐slice scanner). Plaque site, volume, calcific content, and arterial remodeling were recorded using dedicated software. Coronary, macrovascular, and microvascular‐related events were assessed over 6.6±0.6 (mean±SD) (range 5.4–7.5) years and all CHD events were adjudicated. Discrimination of CHD events (cardiovascular death, myocardial infarction, unstable angina, or new‐onset angina requiring intervention) (n=41) was improved by addition of total plaque burden to the clinical risk and coronary artery calcium scores combined (C=0.789 versus 0.763, P=0.034) and further improved by addition of an angiographic score (C=0.824, P=0.021). Independent predictors of a CHD event were United Kingdom Prospective Diabetes Study risk score (hazard ratio 1.3 per 10% 10‐year risk, P=0.003) and the angiographic score (hazard ratio 3.2 per quartile, P<0.0001). Classification was improved over that by United Kingdom Prospective Diabetes Study and coronary artery calcium scores alone (overall net reclassification improvement 0.24). In subjects with coronary plaque (N=500), mild plaque calcification independently predicted a CHD event (hazard ratio 3.0, P=0.02). Computed tomography angiography predicted combined macrovascular but not microvascular‐related events.ConclusionsComputed tomography angiography provides additional prognostic information in asymptomatic type 2 diabetics not obtainable from clinical risk assessment and coronary artery calcium alone.

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

“…One year later, a study of 630 diabetic subjects without known CAD underlined that a combination of CCTA with clinical risk stratification methods and coronary artery calcium score is effective in detecting patients with greater risk of primary cardiovascular events (Table II) (41).…”

Cardiac Computed Tomography Angiographic Findings as Predictors of Late Heart Failure in an Asymptomatic Diabetic Cohort: An 8-Year Prospective Follow-Up Study

“…Eligible subjects had type 2 diabetes mellitus, were aged 55-74 years, had no history of CAD or HF, but had at least 1 additional cardiovascular (CV) risk factor [10]. The study was approved by the hospital Ethics Committee and all subjects provided written informed consent before inclusion in study procedures.…”

“…CTA was performed between October 2006 and October 2008 with a 64-slice scanner (Brilliance CT, Philips Healthcare, Cleveland, OH, USA) using a spiral, retrospective, ECG-gated protocol as previously described [10]. Beta-blockers and sublingual nitrates were used routinely.…”

“…Cardiac computed tomography angiography (CTA) is well suited to examining the role of CAD and structural cardiac changes in the appearance of late HF in this population. We prospectively followed a population-based cohort of type 2 diabetics with no prior history of HF or clinical CAD who were included in a prospective study examining the role of cardiac CTA in predicting outcomes in asymptomatic diabetics [10]. Subjects underwent clinical assessment, coronary artery calcium (CAC) scoring, and cardiac CTA to examine the incremental value of CTA findings in predicting late HF hospitalization or CV death (HF-CVD) during a 7- to 9-year follow-up period.…”

Type 2 Diabetes and Heart Failure - More Scrutiny Wanted!

“…Interestingly, another publication by the same study group refers to a previous study in the same patient cohort where maximal treadmill exercise was studied in diabetic patients [10]. It was shown that the maximal exercise level was not an independent predictor of coronary heart disease outcome events.…”