title: Contributors to mortality in high-risk diabetic patients in the Diabetes Heart Study.
abstract: OBJECTIVE
  Not all individuals with type 2 diabetes and high coronary artery calcified plaque (CAC) experience the same risk for adverse outcomes. This study examined a subset of high-risk individuals based on CAC >1,000 mg (using a total mass score) and evaluated whether differences in a range of modifiable cardiovascular disease (CVD) risk factors provided further insights into risk for mortality.
  
  
  METHODS
  We assessed contributors to all-cause mortality among 371 European American individuals with type 2 diabetes and CAC >1,000 from the Diabetes Heart Study (DHS) after 8.2 ± 3.0 years (mean ± SD) of follow-up. Differences in known CVD risk factors, including modifiable CVD risk factors, were compared between living (n = 218) and deceased (n = 153) participants. Cox proportional hazards regression models were used to quantify risk for all-cause mortality.
  
  
  RESULTS
  Deceased participants had a longer duration of type 2 diabetes (P = 0.02) and reduced use of cholesterol-lowering medications (P = 0.004). Adjusted analyses revealed that vascular calcified plaque scores were associated with increased risk for mortality (hazard ratio 1.31-1.63; 3.89 × 10(-5) < P < 0.03). Higher HbA1c, lipids, and C-reactive protein and reduced kidney function also were associated with a 1.1- to 1.5-fold increased risk for mortality (3.45 × 10(-6) < P < 0.03) after adjusting for confounding factors.
  
  
  CONCLUSIONS
  Even in this high-risk group, vascular calcification and known CVD risk factors provide useful information for ongoing assessment. The use of cholesterol-lowering medication seemed to be protective for mortality.
authors.affiliation: Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cox
authors.affiliation: Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Fang-Chi
authors.initials: FC
authors.lastname: Hsu
authors.affiliation: Department of Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
authors.affiliation: Department of Internal Medicine-Cardiology, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.affiliation: Department of Radiologic Sciences, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC dbowden@wakehealth.edu.
authors.forename: Donald W
authors.initials: DW
authors.lastname: Bowden
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D002423:Cause of Death; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D061205:Vascular Calcification / Q000209:etiology / Q000401:mortality; D044465:White People
chemical_list: D002097:C-Reactive Protein