Coronary calcification, homocysteine, C-reactive protein and the metabolic syndrome in Type 2 diabetes: the Prospective Evaluation of Diabetic Ischaemic Heart Disease by Coronary Tomography (PREDICT) Study.
OBJECTIVE
The PREDICT Study aims to determine: (i) the association between cardiovascular risk factors and coronary artery calcification score (CACS) obtained by electron beam tomography and (ii) the predictive value of CACS for coronary heart disease (CHD) events in Type 2 diabetes.


METHODS
Having previously reported relationships between CACS and conventional risk factors, we have now studied the novel risk factors, plasma high-sensitivity C-reactive protein (CRP) and homocysteine, insulin resistance, serum apoprotein A1 and B concentrations, the serum triglyceride/high-density lipoprotein cholesterol ratio and metabolic syndrome (International Diabetes Federation definition) in 573 subjects of the PREDICT Type 2 diabetes cohort.


RESULTS
In univariate analyses, the only significant positive novel correlate of CACS was homocysteine (P = 0.0004). CRP was increased in those with detectable calcification, but decreased with increasing calcification score (P = 0.006). In a multivariate model that included all significant univariate correlates, CACS was independently associated with age (P < 0.0001), waist-hip ratio (P < 0.02), male gender (P < 0.05) and duration of diabetes (P < 0.05), but the association with homocysteine was no longer significant. The negative association between CACS and CRP remained in multivariate analysis, and was independent of statin use.


CONCLUSIONS
Age was the major factor influencing CACS in Type 2 diabetes, with weaker contributions from waist hip-ratio and duration of diabetes. Other novel cardiovascular risk factors appear to have little positive effect.
Godsland
I F
IF
Endocrinology and Metabolic Medicine, Imperial College London, London, UK. i.godsland@imperial.ac.uk
Elkeles
R S
RS
Feher
M D
MD
Nugara
F
F
Rubens
M B
MB
Richmond
W
W
Khan
M
M
Donovan
J
J
Anyaoku
V
V
Flather
M D
MD
D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism*; D002114:Calcinosis / Q000175:diagnosis*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis*; D003925:Diabetic Angiopathies / Q000175:diagnosis*; D006711:Homocystine / Q000378:metabolism*; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D006711:Homocystine; D002097:C-Reactive Protein