Diabetic Atherosclerosis Management Can Be Personalized Using Coronary Artery Calcium Score

MedicalResearch.com Interview with:
Dr. MalikDr. Shaista Malik MD PhD MPH
Director of Samueli Center For Integrative Medicine
Assistant Professor, School of Medicine
University of California, Irvine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Having diabetes has been considered to be a risk equivalent to already had a myocardial infarction for predicting future cardiovascular events.  We were interested in testing whether further risk stratification in those with diabetes and metabolic syndrome, using coronary artery calcium (CAC), would result in improved prediction of cardiovascular events.

We found that CAC score was associated with incident coronary heart disease and cardiovascular disease more than a decade after the scoring was performed.  We also found that even after we controlled for the duration of diabetes (of 10 years or more), insulin use, or hemoglobin A1c level, coronary artery calcium remained a predictor of cardiovascular events.

Coronary arteriesAuthor Anatomist90

Coronary arteries (Wikipedia image)

Our study shows that many patients with diabetes may have no evidence of coronary artery disease, as evidenced by a zero calcium score on a cardiac CT scan.  Having a zero calcium score has long-term predictive value for cardiovascular events.

Many of the treatment guidelines suggest aggressive management of those with diabetes.  In addition, in those with diabetes duration of greater than 10 years, the American Diabetes Association does not recommend aggressive hyperglycemia management due to prior trials showing an elevated risk for cardiovascular events in those with long-standing diabetes.  It was presumed that those with long-standing diabetes already have atherosclerosis and aggressive hyperglycemic management may put them at risk for complications.

Instead of using diabetes duration as a marker of risk, it maybe more useful to measure subclinical atherosclerosis using coronary artery calcium and personalize treatment based on presence and severity of coronary artery calcium.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Diabetes is a heterogenous condition and coronary artery calcium can be useful in determining risk for cardiovascular disease events.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future trials examining therapy in those with diabetes may need to also assess subclinical atherosclerosis using coronary artery calcium to further personalize therapy.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


Shaista Malik, Yanglu Zhao, Matthew Budoff, Khurram Nasir, Roger S. Blumenthal, Alain G. Bertoni, Nathan D. Wong. Coronary Artery Calcium Score for Long-term Risk Classification in Individuals With Type 2 Diabetes and Metabolic Syndrome From the Multi-Ethnic Study of Atherosclerosis. JAMA Cardiol. Published online November 08, 2017. doi:10.1001/jamacardio.2017.4191

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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