Abstract Details

Session title: Macrovascular and related complications

Session type: Oral Poster

Track: Science of Diabetic Complications

Presentation number: OP-0025

Abstract title:

Coronary artery calcium and diabetic kidney disease: markers of preclinical atherosclerosis and aggressive therapy need

Presenting Author: Sinha A K

Background

Coronary artery disease (CAD) is the foremost cause of death in many countries and hence, its early diagnosis is usually concerned as a major healthcare priority. Coronary artery calcium scoring (CACS) using either electron beam computed tomography (EBCT) or multislice computed tomography (MSCT) has been applied for more than 20 years to provide an early CAD diagnosis in clinical routine practice.

Moreover, its association with other body organs has been a matter of vast research.

Aim

To determine the spectrum of Coronary Artery Calcium CAC Scores in type 2 diabetes and its correlations to renal dysfunction, to serve as surrogate indices of preclinical atherosclerosis, marking the need for aggressive therapy for cardiovascular prophylaxis.

The coronary artery calcium (CAC) score is an independent predictor of coronary heart disease. We sought to combine information from the CAC score with information from conventional cardiac risk factors to determine whether the score may add clinically useful information. CAC scores can be used to predict death in asymptomatic individuals for as long as next 15 years.

Method

CAC scores [Multidetector CT scan (MDCT)] were evaluated in 2248 consecutive patients with type 2 diabetes [Mean age= 62 y; duration of diabetes= 16 y; HbA1c= 8.5; FBG= 189; PPBG= 207; 71% hypertension on one or more medicines; hypertension duration= 15 y; BP= 131/74; no known symptoms / clinical history of atherosclerotic cardiovascular disease; all on cardiovascular prophylaxis with statins and antiplatelet drugs (unless contraindicated); body weight= 72 kgs; Serum cholesterol= 168; HDLc= 45; triglycerides= 179; LDLc= 91; ECHO LVEF= 57%.

Results

Coronary artery calcium score: Calcification grade = risk of imminent coronary event: 0= None; 0-10= Minimum; 11-100= Mild; 101-400= Moderate; 401-1000= Severe; >1000= Very severe.

CAC Group   % Percent  DM duration  DM age onset     Age at study
A: 0-10	          37	           12	             44	                   56
B: 11-100        20	           14	             51	                   65
C: 101-400     27             13	             47                         60
D: > 400	16               22	             47                          69				
P value	                        < 0.001	                                        < 0.001	
		
CAC Group % Percent  Systolic BP Diastolic BP HTN age onset HTN Duration
A: 0-10	          37         	128 	75		       42	                     11
B: 11-100	  20          	131	        69		       50	                     13
C: 101-400	  27	                131	        79		       48	                     12
D: > 400	16	                134	        70		       57	                     14
P value		                        0.08			< 0.001	                 < 0.001

CAC Group  % Percent   HbA1c   FBG   PPBG			
A: 0-10	        37	            8.3	    160    243			
B: 11-100	20                9.7	     170    210			
C: 101-400	27	             8.2	      269   164			
D: > 400	16	             7.9            124   165	
 P value		

CAC Group % Percent   TChol  LDLc    HDLc	 TG		
A: 0-10	      37	          180	98	    49	194		
B: 11-100    20	         158	76	    42	178		
C: 101-400  27	         167	91	    42	182		
D: > 400     16	          149	91	   41	130		
P value			< 0.0001		


CAC Group % Percent   Serum Creatinine    eGFR    UAC
A: 0-10	        37	           0.6	                       109	        22
B: 11-100	20	           0.8	                        94          	50
C: 101-400	27	           0.8	                        92	        45
D: > 400	16	           0.9	                        77	        59
P value		                  <0.001	                     < 0.01  < 0.0001

Discussion


CAC testing is very useful for guiding interventions to prevent coronary heart disease (CHD).

CAC scores predict risk for CHD events, and higher risk individuals are more likely to benefit from prevention interventions such as aspirin and statins.

Clinicians should integrate information from the CAC score, conventional risk factors and non traditional risk factors like GFR, which can change assessment of coronary heart disease risk to an extent that may be clinically important.

Preclinical atherosclerosis - reflected by CAC score - starts very early in DKD, and may be responsible for the increased cardiovascular morbidity in early stage DKD.

Use of CAC Score plus traditional and non-traditional risk factors substantially enhances the ability to classify asymptomatic persons without known CVD into clinically accepted categories of risk of future CHD events.