title: Prevalence and severity of coronary artery calcium in young persons with diabetes.
abstract: BACKGROUND
  Currently, American Diabetes Association guidelines suggest statin use among persons with diabetes mellitus aged >40 years. The presence of calcified plaque in coronary arteries is a sensitive surrogate of coronary artery disease and has been shown to be an independent predictor of mortality and cardiac events.
  
  
  OBJECTIVE
  We aimed to assess the prevalence and severity of calcified plaque in coronary arteries in patients aged <40 years with and without diabetes.
  
  
  METHODS
  We included 3723 asymptomatic patients aged <40 years who had undergone coronary calcium scanning. Clinical and demographic data were collected. Agatston score was categorized into Agatston score 0 as normal, 1 to 99 as low, 100 to 399 as intermediate, and ≥400 as severe; and statistical analysis was performed.
  
  
  RESULTS
  The study population consisted of 4% persons with diabetes (n = 142) and 56% men with a mean age of 35 ± 5 years. Young persons with diabetes had greater prevalence of Agatston score > 0 than persons without diabetes (43% vs 24%; P < .0001). In addition, 12% of persons with diabetes vs 2.5% of persons without diabetes had an Agatston score ≥ 100 (P < .0001). The prevalence of calcified plaque in coronary arteries was >50% in persons with diabetes aged >35 years. After taking into account risk factors, the presence of diabetes was associated with a 4-fold higher odds of an Agatston score ≥ 100 (odds ratio, 4.19; 95% CI, 2.29-7.65; P < .0001).
  
  
  CONCLUSIONS
  Our study found that 43% of young patients with diabetes have detectable coronary atherosclerosis. Given the known clinical implications of calcified plaque in coronary arteries, future studies are needed to evaluate interventions in persons aged <40 years who exhibit subclinical atherosclerosis to reduce future cardiovascular disease events in this vulnerable population.
authors.affiliation: Department of Medicine, Los Angeles Biomedical Research Institute at Harbor University of California, Los Angeles, 1124 West Carson Street, Torrance, CA 90502.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Daga
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Hamirani
authors.forename: John
authors.initials: J
authors.lastname: Tayek
authors.forename: Philip
authors.initials: P
authors.lastname: Bach
authors.forename: Dong
authors.initials: D
authors.lastname: Li
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D000328:Adult; D000367:Age Factors; D002140:California / Q000453:epidemiology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000453:epidemiology*
keywords: Atherosclerosis; Coronary artery calcium; Diabetes; Prevalence; Prognosis