Low short-term and long-term cardiovascular and all-cause mortality in absence of coronary artery calcium: A 22-year follow-up observational study from large cohort

Shaikh, Kashif; Dong, Li; Nakanishi, Rine; Kinninger, April; Almeida, Simone Gonçalves de; Cherukuri, Lavanya; Shekar, Chandana; Roy, Sion K.; Birudaraju, Divya; Rai, Kelash; Ahmad, Khadije; Shafter, Ahmed M; Kumar, Anoop; Hamal, Sajad; Alla, Venkata; Budoff, Matthew J.

doi:10.1016/j.jdiacomp.2019.05.015

Cited by 13 publications

(7 citation statements)

References 27 publications

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“…9 Interestingly, one-third of persons with T2D have no CAC and harbour a risk of CVD close that of the general population. 10,11 Conversely, a large number of persons with T2D suffer from silent, undiagnosed significant coronary artery disease (CAC score above 400). They have five times higher mortality rates than the general population.…”

Section: Introductionmentioning

confidence: 99%

<p>Feasibility Study of Advanced Cardiovascular Screening in Middle-Aged Patients with Diabetes</p>

Lindholt¹,

Frystyk²,

Hallas³

et al. 2020

CLEP

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Purpose: Cardiovascular mortality remains high among patients with diabetes compared with the general population. The primary aim was to evaluate the interest in and demand for advanced cardiovascular screening in patients with diabetes; the secondary aim was to explore its efficiency in detecting unprotected subclinical cardiovascular disease (CVD). Patients and Methods: In a cross-sectional design, randomly selected 40-60-year-old men and women with diabetes were invited to the screening trial. Screening encompassed (1) a comprehensive medical interview; (2) non-contrast computed tomography scanning to quantify coronary artery and aortic valve calcification, to measure left atrial size, to assess heart rhythm and to detect aortic and iliac dilatations; (3) ankle and brachial blood pressure measurements; and (4) blood and urine samples for measurements of HbA 1c , lipid profile, renal function, NT-pro B-type natriuretic peptide (pro-BNP) and albuminuria. Primary outcome was participation rate; secondary outcome was rate of unprotected subclinical CVD. Results: Of 465 invited patients, 191 (41.1%) attended screening. The participation rate was 40% (95% CI:33-47) for males and 42% (95% CI:36-48) for females. Twenty-four patients were excluded due to previous CVD. The remaining patients' mean age was 52 years; 58% were males. Subclinical CVD was found in 64%, with a male preponderance (males 75% (95% CI:66-83; females 49% (95% CI:37-60)). Presence of severe coronary artery calcification (score ≥ 400) showed a male preponderance (males 19% (95% CI:12-27); females 7% (95% CI:3-16)). Aortic valve calcification, enlarged left atrial volume, atrial fibrillation, aortic dilatations, peripheral artery disease or increased pro-BNP were uncommon, and without any sex differences. Unprotected subclinical CVD was very common, and medical treatment was intensified in 60% (95% CI:53-68) of patients. Conclusion: We propose a feasible cardiovascular screening examination from which middle-aged patients with diabetes may benefit. However, the participation rate may be too low to warrant screening.

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Section: Introductionmentioning

confidence: 99%

<p>Feasibility Study of Advanced Cardiovascular Screening in Middle-Aged Patients with Diabetes</p>

Lindholt¹,

Frystyk²,

Hallas³

et al. 2020

CLEP

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“…Other studies have tried to evaluate prognostic differences between diabetic men and women since it was assumed that diabetic women were at increased risk of developing cardiovascular disease. Shaikh et al [ 52 ] studied a court of 25,663 patients with and without diabetes. During follow-up of 22 years, the all-cause mortality rate was low in patients with CAC = 0 (2.6% and 3.9% in female and males) diabetes patients, while patients with CAC score > 300 had an almost six- and threefold increased risk of mortality with respect to people with no or low CAC score.…”

Section: Resultsmentioning

confidence: 99%

Prognostic Value of Coronary Calcium Score in Asymptomatic Individuals: A Systematic Review

Tramontano¹,

Punzo²,

Clemente

et al. 2022

JCM

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Despite updated guidelines and technological developments that allow for an accurate diagnosis, many asymptomatic individuals have a high risk of developing CAD or cardiac events. The CAC score can estimate a correct risk level for these subjects, which is clinically significant for adequate management of risk factors and obtaining personalized preventive therapy. This systematic review aims to assess the prognostic value of CAC score in asymptomatic individuals. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature search was performed to identify original articles since 2010 that evaluated the prognostic value of CAC score in asymptomatic individuals. The quality of the included studies was assessed by the QUIPS tool. A total of 45 articles were selected. Many of these (25 studies) evaluated the prognostic value of CAC score in asymptomatic subjects. In comparison, others (20 studies) evaluated the association of CAC score with other clinical parameters and imaging modalities or the comparison with computed tomography coronary angiography (CTCA). Our findings showed that the CAC score provides valuable prognostic information for predicting CAD risk in asymptomatic individuals.

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“…For example, calcification within the coronary arteries, in contrast to LDL-C, is a reliable measure of CVD risk. Coronary artery calcium (CAC) scoring has proven to be the single best predictor of fatal and nonfatal coronary events [72][73][74][75], including CVD risk in diabetic and nondiabetic patients [76][77][78], as well as in young, mid-age and elderly patients [79]. CAC scoring also excels at long-term risk prediction over periods of more than a decade [76,78,80].…”

Section: Key Pointsmentioning

confidence: 99%

“…Coronary artery calcium (CAC) scoring has proven to be the single best predictor of fatal and nonfatal coronary events [72][73][74][75], including CVD risk in diabetic and nondiabetic patients [76][77][78], as well as in young, mid-age and elderly patients [79]. CAC scoring also excels at long-term risk prediction over periods of more than a decade [76,78,80]. Moreover, among those with genetically confirmed FH, approximately half showed no detectable CAC and had a favorable prognosis, despite significantly elevated LDL-C levels [81].…”

Section: Key Pointsmentioning

confidence: 99%

Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet

Diamond

Bikman

Mason

2022

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewAlthough there is an extensive literature on the efficacy of the low carbohydrate diet (LCD) for weight loss and in the management of type 2 diabetes, concerns have been raised that the LCD may increase cardiovascular disease (CVD) risk by increasing the level of low-density lipoprotein cholesterol (LDL-C). We have assessed the value of LDL-C as a CVD risk factor, as well as effects of the LCD on other CVD risk factors. We have also reviewed findings that provide guidance as to whether statin therapy would be beneficial for individuals with high LDL-C on an LCD. Recent findingsMultiple longitudinal trials have demonstrated the safety and effectiveness of the LCD, while also providing evidence of improvements in the most reliable CVD risk factors. Recent findings have also confirmed how ineffective LDL-C is in predicting CVD risk. SummaryExtensive research has demonstrated the efficacy of the LCD to improve the most robust CVD risk factors, such as hyperglycemia, hypertension, and atherogenic dyslipidemia. Our review of the literature indicates that statin therapy for both primary and secondary prevention of CVD is not warranted for individuals on an LCD with elevated LDL-C who have achieved a low triglyceride/HDL ratio. Keywords atherogenic dyslipidemia, carbohydrate restriction, cardiovascular disease, insulin-resistant phenotype, ketogenic diet, metabolic syndrome, obesity '.. there are things we know we know. We also know there are known unknowns; that is to say, we know there are some things we do not know.'

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Low short-term and long-term cardiovascular and all-cause mortality in absence of coronary artery calcium: A 22-year follow-up observational study from large cohort

Cited by 13 publications

References 27 publications

<p>Feasibility Study of Advanced Cardiovascular Screening in Middle-Aged Patients with Diabetes</p>

<p>Feasibility Study of Advanced Cardiovascular Screening in Middle-Aged Patients with Diabetes</p>

Prognostic Value of Coronary Calcium Score in Asymptomatic Individuals: A Systematic Review

Statin therapy is not warranted for a person with high LDL-cholesterol on a low-carbohydrate diet

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