title: Impact of subclinical atherosclerosis on cardiovascular disease events in individuals with metabolic syndrome and diabetes: the multi-ethnic study of atherosclerosis.
abstract: OBJECTIVE
  While metabolic syndrome (MetS) and diabetes confer greater cardiovascular disease (CVD) risk, recent evidence suggests that individuals with these conditions have a wide range of risk. We evaluated whether screening for coronary artery calcium (CAC) and carotid intimal-medial thickness (CIMT) can improve CVD risk stratification over traditional risk factors (RFs) in people with MetS and diabetes.
  
  
  METHODS
  We assessed CAC and CIMT in 6,603 people aged 45-84 years in the Multi-Ethnic Study of Atherosclerosis (MESA). Cox regression examined the association of CAC and CIMT with coronary heart disease (CHD) and CVD over 6.4 years in MetS and diabetes.
  
  
  RESULTS
  Of the subjects, 1,686 (25%) had MetS but no diabetes and 881 (13%) had diabetes. Annual CHD event rates were 1.0% among MetS and 1.5% for diabetes. Ethnicity and RF-adjusted hazard ratios for CHD for CAC 1-99 to ≥400 vs. 0 in subjects with neither MetS nor diabetes ranged from 2.6 to 9.5; in those with MetS, they ranged from 3.9 to 11.9; and in those with diabetes, they ranged from 2.9 to 6.2 (all P < 0.05 to P < 0.001). Findings were similar for CVD. CAC increased the C-statistic for events (P < 0.001) over RFs and CIMT in each group while CIMT added negligibly to prediction over RFs.
  
  
  CONCLUSIONS
  Individuals with MetS or diabetes have low risks for CHD when CAC or CIMT is not increased. Prediction of CHD and CVD events is improved by CAC more than by CIMT. Screening for CAC or CIMT can stratify risk in people with MetS and diabetes and support the latest recommendations regarding CAC screening in those with diabetes.
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California–Irvine, Irvine, California, USA.
authors.forename: Shaista
authors.initials: S
authors.lastname: Malik
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.forename: Roger S
authors.initials: RS
authors.lastname: Blumenthal
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Moyses
authors.initials: M
authors.lastname: Szklo
authors.forename: R Graham
authors.initials: RG
authors.lastname: Barr
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology* / Q000208:ethnology*; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000208:ethnology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D008875:Middle Aged; D016016:Proportional Hazards Models