John Jeffrey Carr
Professor of Radiology, Biomedical Informatics and Cardiovascular Medicine
Last active: 9/11/2017

Prediction of mortality using a multi-bed vascular calcification score in the Diabetes Heart Study.

Cox AJ, Hsu FC, Agarwal S, Freedman BI, Herrington DM, Carr JJ, Bowden DW
Cardiovasc Diabetol. 2014 13: 160

PMID: 25496604 · PMCID: PMC4266952 · DOI:10.1186/s12933-014-0160-5

BACKGROUND - Vascular calcified plaque, a measure of subclinical cardiovascular disease (CVD), is unlikely to be limited to a single vascular bed in patients with multiple risk factors. Consideration of vascular calcified plaque as a global phenomenon may allow for a more accurate assessment of the CVD burden. The aim of this study was to examine the utility of a combined vascular calcified plaque score in the prediction of mortality.

METHODS - Vascular calcified plaque scores from the coronary, carotid, and abdominal aortic vascular beds and a derived multi-bed score were examined for associations with all-cause and CVD-mortality in 699 European-American type 2 diabetes (T2D) affected individuals from the Diabetes Heart Study. The ability of calcified plaque to improve prediction beyond Framingham risk factors was assessed.

RESULTS - Over 8.4 ± 2.3 years (mean ± standard deviation) of follow-up, 156 (22.3%) participants were deceased, 74 (10.6%) from CVD causes. All calcified plaque scores were significantly associated with all-cause (HR: 1.4-1.8; p < 1x10(-5)) and CVD-mortality (HR: 1.5-1.9; p < 1×10(-4)) following adjustment for Framingham risk factors. Associations were strongest for coronary calcified plaque. Improvement in prediction of outcome beyond Framingham risk factors was greatest using coronary calcified plaque for all-cause mortality (AUC: 0.720 to 0.757, p = 0.004) and the multi-bed score for CVD mortality (AUC: 0.731 to 0.767, p = 0.008).

CONCLUSIONS - Although coronary calcified plaque and the multi-bed score were the strongest predictors of all-cause mortality and CVD-mortality respectively in this T2D-affected sample, carotid and abdominal aortic calcified plaque scores also significantly improved prediction of outcome beyond traditional risk factors and should not be discounted as risk stratification tools.

MeSH Terms (12)

Aged Cardiovascular Diseases Diabetes Mellitus, Type 2 Female Humans Male Middle Aged Plaque, Atherosclerotic Predictive Value of Tests Risk Factors Tomography, X-Ray Computed Vascular Calcification

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