Author + information
- Received September 14, 2018
- Revision received November 13, 2018
- Accepted January 3, 2019
- Published online July 1, 2019.
- Matthew Budoff, MDa,∗ (, )
- Jye-Yu C. Backlund, MPHb,
- David A. Bluemke, MD, PhDc,
- Joseph Polak, MD, MPHd,
- Ionut Bebu, PhDb,
- David Schade, MDe,
- Suzanne Strowig, MSNf,
- Philip Raskin, MDf,
- John M. Lachin, ScDb,
- for the DCCT/EDIC Research Group∗
- aLos Angeles Biomedical Research Institute at Harbor-University of California Los Angeles School of Medicine, Torrance, California
- bDepartment of Biostatistics, George Washington University, Rockville, Maryland
- cDepartment of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- dDepartment of Medicine, Lemuel Shattuck Hospital and Tufts University School of Medicine, Boston, Massachusetts
- eDepartment of Medicine, University of New Mexico, Albuquerque, New Mexico
- fDepartment of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
- ↵∗Address for correspondence:
Dr. Matthew Budoff, Division of Cardiology, Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, California 90502.
Objectives This study sought to determine the relationship between coronary artery calcium (CAC) scores and subsequent cardiovascular disease (CVD) events in DCCT (Diabetes Control and Complications Trial)/EDIC (Epidemiology of Diabetes Interventions and Complications) participants.
Background The CAC score has been validated for improved risk stratification in general populations; however, this association has not been well studied in type 1 diabetes (T1DM).
Methods Computed tomography (CT) to measure CAC was performed in 1,205 DCCT/EDIC participants at a mean of 42.8 years of age during EDIC years 7 to 9, after the end of DCCT. This study analyzed the association between CAC and time to the first subsequent CVD event or to the first major adverse cardiac event (MACE), a follow-up of 10 to 13 years. CAC was categorized as: 0, >0 to 100, >100 to 300, or >300 Agatston units.
Results Of 1,156 participants at risk for subsequent CVD, 105 had an initial CVD event (8.5 per 1,000 patient-years); and of 1,187 participants at risk for MACE, 51 had an initial MACE event (3.9 per 1,000 patient-years). Event rates among those with scores of zero (n = 817 [70.7%]) were very low for CVD (5.6 per 1,000 patient years). CAC scores >100 to 300 (hazard ratio [HR]: 4.17, 5.40) and >300 (HR: 6.06, 6.91) were associated with higher risks of CVD and MACE, respectively, compared to CAC of 0 (p < 0.0001). CAC scores >0 to 100 were nominally associated with CVD (HR: 1.71; p = 0.0415) but not with MACE (HR: 1.11; p = 0.8134). Similar results were observed when also adjusted for mean HbA1c and conventional CVD risk factors. The increment in the AUC due to CAC was modest.
Conclusions CAC scores >100 Agatston units were significantly associated with an increased risk of the subsequent occurrence of CVD and MACE in DCCT/EDIC cohort. (Diabetes Control and Complications Trial [DCCT]; NCT00360815; Epidemiology of Diabetes Interventions and Complications [EDIC]; NCT00360893)
- cardiovascular disease
- coronary artery calcification
- major adverse cardiovascular event
- type 1 diabetes
↵∗ A complete list of participants in the DCCT/EDIC Research Group is presented in the Supplemental Material published online for the article in N Engl J Med 2015;372:1722–33.
The DCCT/EDIC studies were supported by cooperative grants (1982 to 1993, 2012 to 2017, and 2017 to 2022) from and contracts (1982 to 2012) with the Division of Diabetes Endocrinology and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Disease (current grants U01 DK094176 and U01 DK094157), and the National Eye Institute, National Institute of Neurologic Disorders and Stroke, General Clinical Research Centers Program (1993 to 2007), and Clinical Translational Science Center Program (2006 to the present). Contributors included Abbott Diabetes Care, Animas, Bayer Diabetes Care, Becton Dickinson, Eli Lilly, Extend Nutrition, Insulet Corp., Lifescan, Medtronic Diabetes, Nipro Home Diagnostics, Nova Diabetes Care, Omron, Perrigo Diabetes Care, Roche Diabetes Care, and Sanofi-Aventis. Contributors provided free or discounted supplies or equipment to support participants’ adherence to the study but had no role in the DCCT/EDIC study. Dr. Budoff has received support from U.S. National Institutes of Health and General Electric. Dr. Raskin is a consultant for Reata Pharmaceutical; and has received support through his institution from Boehringer-Ingelheim Pharmaceutical and Gan & Lee Pharmaceutical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 14, 2018.
- Revision received November 13, 2018.
- Accepted January 3, 2019.
- 2019 American College of Cardiology Foundation
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