Table 1

Studies of CAC Scanning in Asymptomatic Patients With Diabetes

First Author (Ref. #)Primary OutcomePatientsMain ResultsAdditional Notes
Wong et al. (48)Inducible ischemia on functional stress testing1,043 asymptomatic patients submitted to MPI and CAC screening; 140 type 2 diabetes and 173 metabolic syndrome patientsIn patients with a CAC score 100–399, the rate of ischemia was 13% vs. 3.6% in the presence or absence of metabolic abnormalities (p < 0.02). In patients with CAC score >400, the rates were 23.4% vs. 13.6% (p = 0.03)The odds of ischemia in patients with metabolic abnormalities were 2-fold greater per SD increase in log CAC score
Anand et al. (49)Inducible ischemia on functional stress testing and cardiovascular outcomes510 asymptomatic type 2 diabetes patients. MPI performed in 127 with CAC score >100During 2.2 years of follow-up, there were 20 cardiovascular events, none in patients with CAC score <10CAC score and MPI interaction term was statistically significant for prediction of events
Raggi et al. (51)All-cause mortality9,474 nondiabetic patients and 903 type 2 diabetes patients followed for 5 years after CAC screening44% higher risk of death for diabetic patients compared with control subjects in each category of CAC score (10, 11–100, 101–400, 401–1,000, and >1,000)Diabetic patients with CAC <10 had the same mortality rate as control subjects with CAC score <10
Malik et al. (34)Incident coronary heart disease events6,603 MESA patients 45–84 years old; 1,686 with the metabolic syndrome and 881 with diabetes mellitus type 2Race and risk factors adjusted HR: 2.9–6.2 for type 2 diabetes patients and 3.9–11.9 for metabolic syndrome patients with increasing CAC score categoriesCAC had incremental prognostic value over traditional risk factors and carotid IMT
Yeboah et al. (50)Incident coronary heart disease events1,343 type 2 diabetes mellitus patients from MESA and Heinz-Nixdorf-Recall studies85 events after 8.5 years of follow-up (6.3%). CAC was a better predictor than FRS and UKPDS (AUC: 0.76, 0.70, and 0.69, respectively, all p < 0.05)CAC improved discrimination of risk compared to the FRS (NRI; 0.19) and UKPDS (NRI: 0.21).
Raggi et al. (61)Retrospective study; occurrence of myocardial infarction and progression of CAC157 type 2 diabetes mellitus patients and 1,153 nondiabetic patients followed for 1–3 yearsDiabetic patients with and without myocardial infarction during follow-up showed a greater CAC score increase compared with control subjectsDiabetes mellitus and systemic hypertension were the best predictors of CAC score progression. Baseline CAC score and statin therapy were the best predictors of myocardial infarction.
Kiramijyan et al. (62)CAC score progression and all-cause mortality296 asymptomatic type 2 diabetic patients and 300 control subjects followed for ∼4.5 yearsHR of death in diabetic patients compared with nondiabetic patients increased from 1.88 to 6.95 as the annual percent change in CAC score increased from <10% to >30%Annual %CAC score increase was greater in diabetic patients (29 + 9% vs. 10 + 7%; p = 0.0001)
Wong et al. (58)Incidence and progression of CAC; occurrence of coronary heart disease events2,927 MESA subjects without CAC at baseline and 2,735 subjects with CAC at baseline. 1,426 patients had the metabolic syndrome, 198 patients had type 2 diabetes mellitus, and 510 patients had both. Follow-up 4.9 ± 1.3 yearsPatients with metabolic disorders had higher incidence and greater progression of CAC score. Patients with metabolic disorders in the highest tertile of CAC progression had a 4- to 4.9-fold higher risk of coronary heart disease events

AUC = area under the curve; CAC = coronary artery calcium; FRS = Framingham risk score; HR = hazard ratio; IMT = intima-media thickness; MESA = Multi-Ethnic Study of Atherosclerosis; MPI = myocardial perfusion imaging; NRI = net reclassification index; UKPDS = United Kingdom Prospective Diabetes Study.