Calcium scoring in diabetic individuals The Cracow Study

1
Calcium scoring in diabetic individualsThe
Cracow Study

• Katarzyna Starzyk
• Mieczyslaw Pasowicz

2
Guidelines for diabetic individuals

• Polskie Towarzystwo Diabetologiczne (2005)
• American Diabetes Association (2005)
• American Heart Association (2002)
• American Association of Clinical
  Endocrinologists (2002)

Diabetologia Praktyczna 20045 Supl. D Diab
Care 200528s69-71 Circulation 2002105132-164,
2231-39 Endocr Pract 20028
3
Hyperglycemia in Poland
normal known diabetes new diagnosis IGT IFG

• 5,6 1.7mln diabetics

NATPOL PLUS 2002
4
Diabetes and the Heart
 

• Nr of diabetics doubling within 30 years
• 300 millions in 2025
• Premature atherosclerosis contributes to 75 of
  deaths
• CAD already present in 25 of patients with
  newly diagnosed type 2 diabetes

5
Diabetes and MI risk in different regions the
INTERHEART study
Yusuf, Lancet 2004364937-52
6
Risk factors and MI risk the
INTERHEART study
Hyperlip
Yusuf, Lancet 2004364937-52
7
Risk factors and MI risk the
INTERHEART study
Hyperlip
Yusuf, Lancet 2004364937-52
8
Risk factors and MI risk the
INTERHEART study
Multiplicative effect
Additive effect
Hyperlip
Yusuf, Lancet 2004364937-52
9
Coronary calcium in diabetics
Hoff , JACC 2003411008-12 Raggi, JACC
2004431663-9
10
Coronary calcium in diabetics
Distribution p lt 0.0005
Case-cohort 139 diabetics vs. 139 nondiabetics

• Schurgin, Diab Care 2001241253-60

11
Coronary calcium in diabetics
N 3389, 195 diabetics - 3194 nondiabetics

• Mielke, Diab Res Clin Pract 20015355-61

12
Coronary calcium in diabetics progression

• N 1310, 157 diabetics, 1153 nondiabetics
• Repeat CT scan after min. 1 year
• Calcium development
• diabetics 42 vs nondiabetics 25 (plt0.05)
• Calcium progression
• 33 greater in diabetics without statins
  (plt0.001)
• 18 greater in diabetics on statins (plt0.001)

Raggi, Hypertension 2005 (Epub Apr 25)
13
Risk of CHD by calcium score
RR
nonfatal MI or coronary death
Diabetes
No diabetes
CS low (lt2.8) interm (2.8-117.8) high
(gt117.8)
Follow-up 6.3 1.4 years N 1312, 296
diabetics (39) - 1016 nondiabetics (64)
14
Risk of CHD by calcium score
RR
nonfatal MI or coronary death
Diabetes
No diabetes
CS low (lt2.8) interm (2.8-117.8 high
(gt117.8)
Follow-up 6.3 1.4 years N 1312, 296
diabetics (39) - 1016 nondiabetics (64)
15
Risk of mortality by calcium score
N 10377, 903 diabetics - 9474
nondiabetics Follow-up 5.0 3.5 years
Raggi, JACC 2004431663-9
16
(No Transcript)
17
Cracow Study

• Screening for cardiovascular risk factors and
  calcium
• 709 asymptomatic participants
• Jan 2002 through Dec 2004
• Referred by general practitioners because of the
  presence of ? 1 risk factor(s)

Cracow study
18
Methods

• Reported conventional cardiovascular risk
  factors
• Measurements
• Blood lipids, fasting glucose, CRP
• MSCT calcium scoring
• Diabetes considered present if reported use of
  oral hypoglycemic agents or insulin
• Diabetics n 72

Cracow study
19
Characteristics diabetics (n 72)
Cracow study
20
Characteristics by calcium score categories
p lt 0.05
Cracow study
21
CRP by calcium score categories
Cracow study
22
Conclusions

• Diabetes is associated with an increased risk of
  CHD, and with more extensive coronary
  calcification
• In diabetics, calcium scoring seems to
  distinguish between those at high risk (positive
  calcium score), and those at low risk (zero
  calcium)
• Calcium scoring may be useful for further risk
  stratification in individuals with diabetes