European Heart Journal Advance Access originally published online on June 23, 2008
European Heart Journal 2008 29(18):2244-2251; doi:10.1093/eurheartj/ehn279
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Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study
1 Endocrinology and Metabolic Medicine, Imperial College London, St Mary's Hospital, Praed Street, London W2 1NY, UK
2 Imperial College NHS Trust, London, UK
3 Beta Cell Unit, Chelsea and Westminster Hospital, London, UK
4 CT Scanning Unit, Royal Brompton Hospital, London, UK
5 National Heart and Lung Institute, Imperial College London, London, UK
6 Clinical Trials and Evaluation Unit, Royal Brompton Hospital, London, UK
7 The Rayne Institute, Royal Free and University College Medical School, London, UK
Received 21 January 2008; accepted 5 June 2008; online publish-ahead-of-print 23 June 2008.
* Corresponding author. Tel: +44 20 7886 1209, Fax: +44 20 7886 1790, Email: robert.elkeles{at}imperial.nhs.uk
See page 2193 for the editorial comment on this article (doi:10.1093/eurheartj/ehn368)
Aims: The PREDICT Study is a prospective cohort study designed to evaluate coronary artery calcification score (CACS) as a predictor of cardiovascular events in type 2 diabetes (T2DM).
Methods and results: A total of 589 patients with no history of cardiovascular disease and with established T2DM had CACS measured, as well as risk factors, including plasma lipoprotein, apolipoprotein, homocysteine and C-reactive protein concentrations, homeostasis model assessment insulin resistance (HOMA-IR), and urine albumin creatinine ratio. Participants were followed for a median of 4 years and first coronary heart disease (CHD) and stroke events were identified as primary endpoints. There were 66 first cardiovascular events (including 10 strokes). CACS was a highly significant, independent predictor of events (P < 0.001), with a doubling in CACS being associated with a 32% increase in risk of events (29% after adjustment). Hazard ratios relative to CACS in the range 0–10 Agatston units (AU) were: CACS 11–100 AU, 5.4 (P = 0.02); 101–400 AU 10.5 (P = 0.001); 401–1000 AU, 11.9 (P = 0.001), and >1000 AU, 19.8 (P < 0.001). Only HOMA-IR predicted primary endpoints independently of CACS (P = 0.01). The areas under the receiver operator characteristic curve for United Kingdom Prospective Diabetes Study (UKPDS) risk engine primary endpoint risk and for UKPDS risk plus CACS were 0.63 and 0.73, respectively (P = 0.03).
Conclusion: Measurement of CACS is a powerful predictor of cardiovascular events in asymptomatic patients with T2DM and can further enhance prediction provided by established risk models.
Key Words: Coronary calcification • Type 2 diabetes • Coronary events • Stroke
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