title: Absence of Coronary Artery Calcium Identifies Asymptomatic Diabetic Individuals at Low Near-Term But Not Long-Term Risk of Mortality: A 15-Year Follow-Up Study of 9715 Patients.
abstract: BACKGROUND
  Data regarding coronary artery calcification (CAC) prognosis in diabetic individuals are limited to 5-years follow-up. We investigated the long-term risk stratification of CAC among diabetic compared with nondiabetic individuals.
  
  
  RESULTS
  Nine thousand seven hundred and fifteen asymptomatic individuals undergoing CAC scoring were followed for a median (interquartile range) of 14.7 (13.9-15.6) years. The incidence density rate and hazard ratios with 95% confidence intervals were used to calculate all-cause mortality. Incremental prognostic utility of CAC was evaluated using the area under the receiver operator characteristic curve and net reclassification improvement. Diabetics (54.7±10.8 years; 59.4% male) comprised 8.3% of the cohort (n=810), of which 188 (23.2%) died. For CAC=0, the rate of mortality was similar between diabetic and nondiabetic individuals for the first 5 years (P>0.05), with a nonlinear increased risk of mortality for diabetics after 5 years (P<0.05). The adjusted risk of death for those in the highest (CAC>400) versus the lowest (CAC=0) category of CAC increased by a hazards of 4.64 (95% confidence interval =3.74-5.76) and 3.41 (95% confidence interval =2.22-5.22) for nondiabetic and diabetic individuals, respectively. The presence of CAC improved discrimination (area under the receiver operator characteristic curve range: 0.73-0.74; P<0.01) and reclassification (category-free net reclassification improvement range: 0.53-0.50; P<0.001) beyond conventional risk factors in nondiabetic and diabetic individuals, respectively.
  
  
  CONCLUSIONS
  CAC=0 is associated with a favorable 5-year prognosis for asymptomatic diabetic and nondiabetic individuals. After 5 years, the risk of mortality increases significantly for diabetic individuals even in the presence of a baseline CAC=0.
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Valentina
authors: V
authors: Valenti
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Bríain Ó
authors: BÓ
authors: Hartaigh
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Iksung
authors: I
authors: Cho
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Joshua
authors: J
authors: Schulman-Marcus
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Heidi
authors: H
authors: Gransar
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Ran
authors: R
authors: Heo
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Quynh A
authors: QA
authors: Truong
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Leslee J
authors: LJ
authors: Shaw
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Joseph
authors: J
authors: Knapper
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Anita A
authors: AA
authors: Kelkar
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Sebastiano
authors: S
authors: Sciarretta
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Hyuk-Jae
authors: HJ
authors: Chang
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.).
authors: Tracy Q
authors: TQ
authors: Callister
authors: From the Department of Radiology, Dalio Institute of Cardiovascular Imaging, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY (V.V., B.ó.H., I.C., R.H., Q.A.T., J.K.M.); Department of Internal Medicine, Section of Geriatrics, Yale School of Medicine, New Haven, CT (B.ó.H.); Department of Medicine, Division of Cardiology, NewYork Presbyterian Hospital/Weill Cornell Medical College, New York, NY (J.S.-M.); Department of Imaging, and Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.); Tennessee Heart and Vascular Institute, Hendersonville (T.Q.C.); Department of Internal Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA (L.J.S., J.K., A.A.K.); IRCCS Neuromed, Pozzilli (IS), Italy (S.S.); Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (S.S.); and Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea (H.-J.C.). jkm2001@med.cornell.edu.
authors: James K
authors: JK
authors: Min
mesh_terms: D002423:Cause of Death; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality*
keywords: calcium score; computed tomography; coronary artery calcium; diabetes mellitus; mortality; prognosis