title: Prediction of mortality using a multi-bed vascular calcification score in the Diabetes Heart Study.
abstract: BACKGROUND
  Vascular calcified plaque, a measure of subclinical cardiovascular disease (CVD), is unlikely to be limited to a single vascular bed in patients with multiple risk factors. Consideration of vascular calcified plaque as a global phenomenon may allow for a more accurate assessment of the CVD burden. The aim of this study was to examine the utility of a combined vascular calcified plaque score in the prediction of mortality.
  
  
  METHODS
  Vascular calcified plaque scores from the coronary, carotid, and abdominal aortic vascular beds and a derived multi-bed score were examined for associations with all-cause and CVD-mortality in 699 European-American type 2 diabetes (T2D) affected individuals from the Diabetes Heart Study. The ability of calcified plaque to improve prediction beyond Framingham risk factors was assessed.
  
  
  RESULTS
  Over 8.4 ± 2.3 years (mean ± standard deviation) of follow-up, 156 (22.3%) participants were deceased, 74 (10.6%) from CVD causes. All calcified plaque scores were significantly associated with all-cause (HR: 1.4-1.8; p < 1x10(-5)) and CVD-mortality (HR: 1.5-1.9; p < 1×10(-4)) following adjustment for Framingham risk factors. Associations were strongest for coronary calcified plaque. Improvement in prediction of outcome beyond Framingham risk factors was greatest using coronary calcified plaque for all-cause mortality (AUC: 0.720 to 0.757, p = 0.004) and the multi-bed score for CVD mortality (AUC: 0.731 to 0.767, p = 0.008).
  
  
  CONCLUSIONS
  Although coronary calcified plaque and the multi-bed score were the strongest predictors of all-cause mortality and CVD-mortality respectively in this T2D-affected sample, carotid and abdominal aortic calcified plaque scores also significantly improved prediction of outcome beyond traditional risk factors and should not be discounted as risk stratification tools.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cox
authors.forename: Fang-Chi
authors.initials: FC
authors.lastname: Hsu
authors.forename: Subhashish
authors.initials: S
authors.lastname: Agarwal
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
authors.forename: J Jeffrey
authors.initials: JJ
authors.lastname: Carr
authors.affiliation: Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA. dbowden@wakehealth.edu.
authors.forename: Donald W
authors.initials: DW
authors.lastname: Bowden
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis / Q000401:mortality*; D011237:Predictive Value of Tests; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D061205:Vascular Calcification / Q000175:diagnosis / Q000401:mortality*