MedicalResearch.com Interview with:
Prof. David A. Halon MB ChB, FACC, FESC
Associate Professor of Clinical Medicine
Technion, Israel Institute of Technology.
Director, Interventional Cardiology
Lady Davis Carmel Medical Center
MedicalResearch.com: What is the background for this study?
Prof. Halon: Type 2 diabetics are well known to have more cardiovascular events than non-diabetics but even among diabetics this risk is heterogeneous and some remain at very low risk. It remains uncertain if additional diagnostic modalities over and above clinical risk scores may be helpful in defining which diabetics are at high risk for an adverse event. We performed a study using cardiac CT angiography (CCTA) in 630 type 2 diabetics 55-74 years of age with no history of coronary artery disease to examine if CTA findings would have additional prognostic value over traditional risk scores for cardiovascular or microvascular based events over 7.5 years of follow-up.
MedicalResearch.com: What are the main findings?
Prof. Halon: We found that CCTA had independent predictive value for cardiovascular events and improved discrimination and risk classification but had no value in the prediction of microvascular related events (retinal and renal). Coronary artery calcium score also improved outcome prediction for cardiovascular events over clinical risk alone but CCTA had further added value. Subjects with no coronary arterial plaque on CCTA (20.6%) had no coronary heart disease events throughout the study period. While the overall extent of coronary plaque measured as plaque length, volume or burden (plaque volume adjusted for arterial volume) was a good outcome predictor the final predictive model for a coronary heart disease event included only a simple CCTA angiographic score together with a clinical risk score specific to diabetics.
MedicalResearch.com: What should readers take away from your report?
Prof. Halon: Amongst asymptomatic type 2 diabetics it is possible to define a high risk and a very low risk cohort using a clinical risk score, coronary artery calcium score and followed when necessary by CCTA the findings from which will have implications for the intensity of preventive measures. Those in the upper decile of risk had 4 times the cardiovascular event rate than the rest of the study cohort combined while 20% of patients with no plaque had minimal risk (no coronary heart disease events).
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Prof. Halon: It has not been shown that widespread screening of asymptomatic diabetics for coronary artery disease will lead to preventive or therapeutic measures that will improve overall outcomes. Clinical trials investigating new preventive therapies might be focused on high risk diabetic cohorts, as defined in this study, in order to reduce the study size, duration and cost while focusing on those in greatest need of preventive therapy. Further analysis of coronary plaque characteristics on CCTA might have additional prognostic value and newer scanners might have greater potential for plaque content and tissue discrimination in this regard.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Coronary Computed Tomography (CT) Angiography as a Predictor of Cardiac and Noncardiac Vascular Events in Asymptomatic Type 2 Diabetics: A 7‐Year Population‐Based Cohort Study
David A. Halon, Mali Azencot, Ronen Rubinshtein, Barak Zafrir, Moshe Y. Flugelman, and Basil S. Lewis
J Am Heart Assoc. 2016;5:e003226, originally published June 13, 2016,doi:10.1161/JAHA.116.003226
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