Author + information
- Received July 24, 2011
- Revision received December 8, 2011
- Accepted December 22, 2011
- Published online April 1, 2012.
- Nathan D. Wong, PhD, MPH⁎,⁎ (, )
- Jennifer C. Nelson, PhD†,‡,
- Tanya Granston, MS‡,
- Alain G. Bertoni, MD, MPH§,
- Roger S. Blumenthal, MD∥,
- J. Jeffrey Carr, MD§,
- Alan Guerci, MD¶,
- David R. Jacobs Jr, PhD#,§§,
- Richard Kronmal, PhD‡,
- Kiang Liu, PhD⁎⁎,
- Mohammed Saad, MD††,
- Elizabeth Selvin, PhD, MPH∥,
- Russell Tracy, PhD‡‡ and
- Robert Detrano, MD, PhD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Nathan D. Wong, Heart Disease Prevention Program, Department of Medicine, Sprague Hall 112, University of California, Irvine, California 92697-4101
Objectives This study sought to examine and compare the incidence and progression of coronary artery calcium (CAC) among persons with metabolic syndrome (MetS) and diabetes mellitus (DM) versus those with neither condition.
Background MetS and DM are associated with subclinical atherosclerosis as evidenced by CAC.
Methods The MESA (Multiethnic Study of Atherosclerosis) included 6,814 African American, Asian, Caucasian, and Hispanic adults 45 to 84 years of age, who were free of cardiovascular disease at baseline. Of these, 5,662 subjects (51% women, mean age 61.0 ± 10.3 years) received baseline and follow-up (mean 2.4 years) cardiac computed tomography scans. We compared the incidence of CAC in 2,927 subjects without CAC at baseline and progression of CAC in 2,735 subjects with CAC at baseline in those with MetS without DM (25.2%), DM without MetS (3.5%), or both DM and MetS (9.0%) to incidence and progression in subjects with neither MetS nor DM (58%). Progression of CAC was also examined in relation to coronary heart disease events over an additional 4.9 years.
Results Relative to those with neither MetS nor DM, adjusted relative risks (95% confidence intervals [CI]) for incident CAC were 1.7 (95% CI: 1.4 to 2.0), 1.9 (95% CI: 1.4 to 2.4), and 1.8 (95% CI: 1.4 to 2.2) (all p < 0.01), and absolute differences in mean progression (volume score) were 7.8 (95% CI: 4.0 to 11.6; p < 0.01), 11.6 (95% CI: 2.7 to 20.5; p < 0.05), and 22.6 (95% CI: 17.2 to 27.9; p < 0.01) for those with MetS without DM, DM without MetS, and both DM and MetS, respectively. Similar findings were seen in analysis using Agatston calcium score. In addition, progression predicted coronary heart disease events in those with MetS without DM (adjusted hazard ratio: 4.1, 95% CI: 2.0 to 8.5, p < 0.01) and DM (adjusted hazard ratio: 4.9 [95% CI: 1.3 to 18.4], p < 0.05) among those in the highest tertile of CAC increase versus no increase.
Conclusions Individuals with MetS and DM have a greater incidence and absolute progression of CAC compared with individuals without these conditions, with progression also predicting coronary heart disease events in those with MetS and DM.
This research was supported by contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute. Dr. Wong reports research funding from Bristol-Myers Squibb through the University of California, Irvine. Dr. Nelson has been a statistical consultant for GlaxoSmithKline. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 24, 2011.
- Revision received December 8, 2011.
- Accepted December 22, 2011.
- American College of Cardiology Foundation