Coronary calcium measurement improves prediction of cardiovascular events in asymptomatic patients with type 2 diabetes: the PREDICT study.
OBJECTIVE
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).


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).


CONCLUSIONS
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.
Elkeles
Robert S
RS
Endocrinology and Metabolic Medicine, Imperial College London, St Mary's Hospital, London, UK. robert.elkeles@imperial.nhs.uk
Godsland
Ian F
IF
Feher
Michael D
MD
Rubens
Michael B
MB
Roughton
Michael
M
Nugara
Fiona
F
Humphries
Steve E
SE
Richmond
William
W
Flather
Marcus D
MD
D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002114:Calcinosis / Q000000981:diagnostic imaging* / Q000378:metabolism; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000000981:diagnostic imaging*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
D002097:C-Reactive Protein