Absence of coronary artery calcium identifies asymptomatic diabetic individuals at low near-term but not long-term risk of mortality: A 15-year follow-up study of 9715 patients

Valentina Valenti, Bríain Hartaigh, Iksung Cho, Joshua Schulman-Marcus, Heidi Gransar, Ran Heo, Quynh A. Truong, Leslee J. Shaw, Joseph Knapper, Anita A. Kelkar, Sebastiano Sciarretta, Hyuk-Jae Chang, Tracy Q. Callister, James K. Min

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Abstract

Background - Data regarding coronary artery calcification (CAC) prognosis in diabetic individuals are limited to 5-years follow-up. We investigated the long-term risk stratification of CAC among diabetic compared with nondiabetic individuals. Methods and Results - Nine thousand seven hundred and fifteen asymptomatic individuals undergoing CAC scoring were followed for a median (interquartile range) of 14.7 (13.9-15.6) years. The incidence density rate and hazard ratios with 95% confidence intervals were used to calculate all-cause mortality. Incremental prognostic utility of CAC was evaluated using the area under the receiver operator characteristic curve and net reclassification improvement. Diabetics (54.7±10.8 years; 59.4% male) comprised 8.3% of the cohort (n=810), of which 188 (23.2%) died. For CAC=0, the rate of mortality was similar between diabetic and nondiabetic individuals for the first 5 years (P>0.05), with a nonlinear increased risk of mortality for diabetics after 5 years (P<0.05). The adjusted risk of death for those in the highest (CAC>400) versus the lowest (CAC=0) category of CAC increased by a hazards of 4.64 (95% confidence interval =3.74-5.76) and 3.41 (95% confidence interval =2.22-5.22) for nondiabetic and diabetic individuals, respectively. The presence of CAC improved discrimination (area under the receiver operator characteristic curve range: 0.73-0.74; P<0.01) and reclassification (category-free net reclassification improvement range: 0.53-0.50; P<0.001) beyond conventional risk factors in nondiabetic and diabetic individuals, respectively. Conclusions - CAC=0 is associated with a favorable 5-year prognosis for asymptomatic diabetic and nondiabetic individuals. After 5 years, the risk of mortality increases significantly for diabetic individuals even in the presence of a baseline CAC=0.

Original languageEnglish
Article numbere003528
JournalCirculation: Cardiovascular Imaging
Volume9
Issue number2
DOIs
Publication statusPublished - 2016 Feb 1

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Coronary Vessels
Calcium
Mortality
Confidence Intervals
Incidence

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Valenti, Valentina ; Hartaigh, Bríain ; Cho, Iksung ; Schulman-Marcus, Joshua ; Gransar, Heidi ; Heo, Ran ; Truong, Quynh A. ; Shaw, Leslee J. ; Knapper, Joseph ; Kelkar, Anita A. ; Sciarretta, Sebastiano ; Chang, Hyuk-Jae ; Callister, Tracy Q. ; Min, James K. / Absence of coronary artery calcium identifies asymptomatic diabetic individuals at low near-term but not long-term risk of mortality : A 15-year follow-up study of 9715 patients. In: Circulation: Cardiovascular Imaging. 2016 ; Vol. 9, No. 2.
@article{333f03c6cb8f477da1027e9e8a717f4a,
title = "Absence of coronary artery calcium identifies asymptomatic diabetic individuals at low near-term but not long-term risk of mortality: A 15-year follow-up study of 9715 patients",
abstract = "Background - Data regarding coronary artery calcification (CAC) prognosis in diabetic individuals are limited to 5-years follow-up. We investigated the long-term risk stratification of CAC among diabetic compared with nondiabetic individuals. Methods and Results - Nine thousand seven hundred and fifteen asymptomatic individuals undergoing CAC scoring were followed for a median (interquartile range) of 14.7 (13.9-15.6) years. The incidence density rate and hazard ratios with 95{\%} confidence intervals were used to calculate all-cause mortality. Incremental prognostic utility of CAC was evaluated using the area under the receiver operator characteristic curve and net reclassification improvement. Diabetics (54.7±10.8 years; 59.4{\%} male) comprised 8.3{\%} of the cohort (n=810), of which 188 (23.2{\%}) died. For CAC=0, the rate of mortality was similar between diabetic and nondiabetic individuals for the first 5 years (P>0.05), with a nonlinear increased risk of mortality for diabetics after 5 years (P<0.05). The adjusted risk of death for those in the highest (CAC>400) versus the lowest (CAC=0) category of CAC increased by a hazards of 4.64 (95{\%} confidence interval =3.74-5.76) and 3.41 (95{\%} confidence interval =2.22-5.22) for nondiabetic and diabetic individuals, respectively. The presence of CAC improved discrimination (area under the receiver operator characteristic curve range: 0.73-0.74; P<0.01) and reclassification (category-free net reclassification improvement range: 0.53-0.50; P<0.001) beyond conventional risk factors in nondiabetic and diabetic individuals, respectively. Conclusions - CAC=0 is associated with a favorable 5-year prognosis for asymptomatic diabetic and nondiabetic individuals. After 5 years, the risk of mortality increases significantly for diabetic individuals even in the presence of a baseline CAC=0.",
author = "Valentina Valenti and Br{\'i}ain Hartaigh and Iksung Cho and Joshua Schulman-Marcus and Heidi Gransar and Ran Heo and Truong, {Quynh A.} and Shaw, {Leslee J.} and Joseph Knapper and Kelkar, {Anita A.} and Sebastiano Sciarretta and Hyuk-Jae Chang and Callister, {Tracy Q.} and Min, {James K.}",
year = "2016",
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doi = "10.1161/CIRCIMAGING.115.003528",
language = "English",
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Valenti, V, Hartaigh, B, Cho, I, Schulman-Marcus, J, Gransar, H, Heo, R, Truong, QA, Shaw, LJ, Knapper, J, Kelkar, AA, Sciarretta, S, Chang, H-J, Callister, TQ & Min, JK 2016, 'Absence of coronary artery calcium identifies asymptomatic diabetic individuals at low near-term but not long-term risk of mortality: A 15-year follow-up study of 9715 patients', Circulation: Cardiovascular Imaging, vol. 9, no. 2, e003528. https://doi.org/10.1161/CIRCIMAGING.115.003528

Absence of coronary artery calcium identifies asymptomatic diabetic individuals at low near-term but not long-term risk of mortality : A 15-year follow-up study of 9715 patients. / Valenti, Valentina; Hartaigh, Bríain; Cho, Iksung; Schulman-Marcus, Joshua; Gransar, Heidi; Heo, Ran; Truong, Quynh A.; Shaw, Leslee J.; Knapper, Joseph; Kelkar, Anita A.; Sciarretta, Sebastiano; Chang, Hyuk-Jae; Callister, Tracy Q.; Min, James K.

In: Circulation: Cardiovascular Imaging, Vol. 9, No. 2, e003528, 01.02.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Absence of coronary artery calcium identifies asymptomatic diabetic individuals at low near-term but not long-term risk of mortality

T2 - A 15-year follow-up study of 9715 patients

AU - Valenti, Valentina

AU - Hartaigh, Bríain

AU - Cho, Iksung

AU - Schulman-Marcus, Joshua

AU - Gransar, Heidi

AU - Heo, Ran

AU - Truong, Quynh A.

AU - Shaw, Leslee J.

AU - Knapper, Joseph

AU - Kelkar, Anita A.

AU - Sciarretta, Sebastiano

AU - Chang, Hyuk-Jae

AU - Callister, Tracy Q.

AU - Min, James K.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Background - Data regarding coronary artery calcification (CAC) prognosis in diabetic individuals are limited to 5-years follow-up. We investigated the long-term risk stratification of CAC among diabetic compared with nondiabetic individuals. Methods and Results - Nine thousand seven hundred and fifteen asymptomatic individuals undergoing CAC scoring were followed for a median (interquartile range) of 14.7 (13.9-15.6) years. The incidence density rate and hazard ratios with 95% confidence intervals were used to calculate all-cause mortality. Incremental prognostic utility of CAC was evaluated using the area under the receiver operator characteristic curve and net reclassification improvement. Diabetics (54.7±10.8 years; 59.4% male) comprised 8.3% of the cohort (n=810), of which 188 (23.2%) died. For CAC=0, the rate of mortality was similar between diabetic and nondiabetic individuals for the first 5 years (P>0.05), with a nonlinear increased risk of mortality for diabetics after 5 years (P<0.05). The adjusted risk of death for those in the highest (CAC>400) versus the lowest (CAC=0) category of CAC increased by a hazards of 4.64 (95% confidence interval =3.74-5.76) and 3.41 (95% confidence interval =2.22-5.22) for nondiabetic and diabetic individuals, respectively. The presence of CAC improved discrimination (area under the receiver operator characteristic curve range: 0.73-0.74; P<0.01) and reclassification (category-free net reclassification improvement range: 0.53-0.50; P<0.001) beyond conventional risk factors in nondiabetic and diabetic individuals, respectively. Conclusions - CAC=0 is associated with a favorable 5-year prognosis for asymptomatic diabetic and nondiabetic individuals. After 5 years, the risk of mortality increases significantly for diabetic individuals even in the presence of a baseline CAC=0.

AB - Background - Data regarding coronary artery calcification (CAC) prognosis in diabetic individuals are limited to 5-years follow-up. We investigated the long-term risk stratification of CAC among diabetic compared with nondiabetic individuals. Methods and Results - Nine thousand seven hundred and fifteen asymptomatic individuals undergoing CAC scoring were followed for a median (interquartile range) of 14.7 (13.9-15.6) years. The incidence density rate and hazard ratios with 95% confidence intervals were used to calculate all-cause mortality. Incremental prognostic utility of CAC was evaluated using the area under the receiver operator characteristic curve and net reclassification improvement. Diabetics (54.7±10.8 years; 59.4% male) comprised 8.3% of the cohort (n=810), of which 188 (23.2%) died. For CAC=0, the rate of mortality was similar between diabetic and nondiabetic individuals for the first 5 years (P>0.05), with a nonlinear increased risk of mortality for diabetics after 5 years (P<0.05). The adjusted risk of death for those in the highest (CAC>400) versus the lowest (CAC=0) category of CAC increased by a hazards of 4.64 (95% confidence interval =3.74-5.76) and 3.41 (95% confidence interval =2.22-5.22) for nondiabetic and diabetic individuals, respectively. The presence of CAC improved discrimination (area under the receiver operator characteristic curve range: 0.73-0.74; P<0.01) and reclassification (category-free net reclassification improvement range: 0.53-0.50; P<0.001) beyond conventional risk factors in nondiabetic and diabetic individuals, respectively. Conclusions - CAC=0 is associated with a favorable 5-year prognosis for asymptomatic diabetic and nondiabetic individuals. After 5 years, the risk of mortality increases significantly for diabetic individuals even in the presence of a baseline CAC=0.

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DO - 10.1161/CIRCIMAGING.115.003528

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