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CAC score predicted all-cause mortality in type 2 diabetes
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It has been established that coronary artery calcium score predicts the risk for cardiovascular events among patients in the general population. However, studies examining this association have infrequently involved patients with diabetes.
In a systemic review and meta-analysis of observational studies identified from Embase and PubMed, as well as abstracts from recent American Diabetes Association, European Association for the Study of Diabetes, American College of Cardiology and American Heart Association annual meetings, researchers sought to examine the association of coronary artery calcium (CAC) score with all-cause mortality and CV events in patients with type 2 diabetes.
According to data, eight studies were included (n=6,521; 802 events; mean follow-up, 5.18 years). The researchers found a statistically significant RR for all-cause mortality, CV events or both when comparing a total CAC score of ≥10 with a score of <10 (RR=5.47; 95% CI, 2.59-11.53). They wrote that the overall sensitivity of a total CAC score of ≥10 for this composite outcome was 94% (95% CI, 89-96), with a specificity of 34% (95% CI, 24-44).
Further data indicate the positive (1.41; 95% CI, 1.20-1.66) and negative (0.18; 95% CI, 0.10-0.30) likelihood ratios for all-cause mortality, CV events or both. The researchers wrote that in patients with a CAC score of <10, the post-test probability of the composite outcome was approximately 1.8%, revealing a 6.8-fold reduction from the pretest probability.
Moreover, four studies examined CV events as the outcome (n=1,805; 351 events). The researchers reported a RR for CV events comparing a total CAC score of ≥10 with a score of <10 as 9.22 (95% CI, 2.73-31.07). Again, they noted a positive (1.67; 95% CI, 1.30-2.17) and negative (0.11; 95% CI, 0.04-0.29) likelihood ratio for all-cause mortality, CV events or both.
These findings add to the literature that a CAC score of ≥10 predicted all-cause mortality, CV events or both compared with a score of <10 (with high sensitivity and low specificity), researchers wrote. This has clinical implications for patients with diabetes who have a score of <10. Those patients could be identified as low-risk patients within an otherwise high-risk population.
Disclosure: See the study for a full list of disclosures.
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