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Coronary Artery Calcification and Cardiovascular Disease in Patients with Type 1 Diabetes

Oct 12, 2019
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences

Is the CAC score a reliable tool in assessing cardio risk in patients with type 1 diabetes?

The purpose of this study was to comprehend the relationship between coronary artery calcification (CAC) score and cardiovascular disease (CVD) in patients from EDIC (Epidemiology of Diabetes Interventions and Complications) and/or DCCT (Diabetes Control and Complications Trial).  Improved risk stratification has been shown with the CAC score in the general population.  CAC score and CVD events have been completed in patients with type 2 diabetes, but there hasn’t been much research on this topic in patients with type 1 diabetes. 

In this study, researchers examined 1,205 patients with type 1 diabetes from the DCCT/EDIC study.  Researchers used a CT scan to measure CAC score in these patients, which was accurate at observing stratify risk in this patient population.  Subjects in this study had a mean age of 42.8 years of age. Researchers studied the association between CAC score and the first incidence of a CVD event or the first major adverse cardiac event (MACE).  Subjects had a follow-up of 10 – 13 years. CAC was classified as: 0, >0 to 100, >100 to 300, or >300 Agatston units.

Of all the patients, 1,156 were at risk of a subsequent CVD and 105 had an incidence of CVD event (8.5 per 1,000 patients-year).  There were 1,187 subjects that were at risk for MACE and 51 of these patients experienced MACE events (3.9 per 1,000 patients-year).  Patients that had an event rate lower than zero had a lower chance of experiencing a CVD event (5.6 per 1,000 patient-years). Patients that had a CAC score of >100 to 300 (hazard ratio [HR]: 4.17, 5.40) and >300 (HR: 6.06, 6.91) were at an increased risk of experiencing a CVD event or MACE, respectively.  When comparing CAC scores >100 and patients with scores of 0 there was a p-value of <0.0001. Patients that had a CAC score of >0 to 100 were associated with normal risk of CVD event (HR: 1.71; p = 0.0415) but not with MACE (HR: 1.11; p = 0.8134). These results were similar in patients that had an adjusted mean HbA1c and conventional CVD risk factors.

The authors concluded that patients in DCCT/EDIC that have a CAC score >100 Agatston units were at an elevated risk of having a CVD event or MACE.  The information that was given in this trial was reliable, but having a controlled study would help us determine if the CAC score is a reliable tool, and if it can be used as a measuring tool for the initiation of statin therapy.

Practice Pearls:

  • Patients with a CAC (coronary artery calcification) score >100 and who have type 1 diabetes were at greater risk of experiencing CVD events or MACE.
  • Patients that have a CAC score lower than zero had lower chance of having a CVD event.
  • Patients that had a CAC score of >0 to 100 were at a normal risk of CVD event but not with MACE.

“The Association of Coronary Artery Calcification With Subsequent Incidence of Cardiovascular Disease in Type 1 Diabetes.” PracticeUpdate, https://www.practiceupdate.com/c/86347/1/8/?elsca1=emc_enews_expert-insight&elsca2=email&elsca3=practiceupdate_diab&elsca4=diabetes&elsca5=newsletter&rid=OTE0MTIxOTE4NTkS1&lid=10332481.

Matthew Budoff, Jye-Yu C. Backlund, et al. “The Association of Coronary Artery Calcification With Subsequent Incidence of Cardiovascular Disease in Type 1 Diabetes.” JACC, JACC: Cardiovascular Imaging, 1 July 2019, http://imaging.onlinejacc.org/content/12/7_Part_2/1341.

Keri Hames, PharmD Candidate, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences