Low short-term and long-term cardiovascular and all-cause mortality in absence of coronary artery calcium: A 22-year follow-up observational study from large cohort

Kashif Shaikh, Dong Li, Rine Nakanishi, April Kinninger, Shone Almeida, Lavanya Cherukuri, Chandana Shekar, Sion K. Roy, Divya Birudaraju, Kelash Rai, Khadije Ahmad, Ahmed Shafter, Anoop Kumar, Sajad Hamal, Venkata (Mahesh) Alla, Mathew J. Budoff

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Abstract

Objectives: We sought to evaluate the gender-specific predictive value of coronary artery calcium (CAC) score on all-cause mortality and cardiovascular disease (CVD) mortality in individuals with and without diabetes mellitus (DM). Background: CAC score is a robust predictor of CVD and all-cause mortality during long-term follow-up in large cohorts in adults with DM. However, less is known about its sex-specific impact on all-cause mortality in DM. Methods: We evaluated 25,563 asymptomatic participants with no known history of coronary artery disease (CAD) who underwent clinically indicated CAC. 1999 (7.8%) individuals had diabetes. CAC was characterized as an Agatston score of 0, 1–99, 100–300, and ≫300. We evaluated the association between CAC and all-cause mortality and CVD mortality. Results: Overall, 1345 individuals died (5.3%) from all causes during a mean follow-up of 14.7 ± 3.8 years. CAC score was 0 in 57.5% females and 34.4% of males without DM, while 36.6% females and 20.3% males with DM had CAC-0. The frequency of CAC ≫ 300 was 18% and 36% in females and males with DM, respectively. CAC score of zero was associated with low all-cause mortality event rate in females and males with diabetes (1.7 and 2.5 events per 1000 person-years, respectively). Cardiovascular mortality per 1000 person years was ≪1 in females and males with CAC score of 0 irrespective of their diabetes. Adjusted multivariable analysis, compared to CAC-0, HR for all-cause mortality associated with CAC 1–99, 100–299 and ≫300 were 1.74(95% CI 0.65, 4.63, P-0.20), 5.54(95% CI 2.16, 14.22, P ≪ 0.001) and 5.75(95% CI 2.30, 14.37, P ≪ 0.001) in females with DM respectively; in males with DM HR associated with CAC 1–99, 100–299 and ≫300 were 1.87(95% CI 0.95, 3.66, P-0.06), 2.15(95% CI 1.05, 4.38, P-0.035) and 2.60(95% CI 1.34, 5.0, P-0.004), respectively. Conclusion: Presence of subclinical atherosclerosis varies among individuals with DM. The absence of CAC was associated with very low cardiovascular as well as all-cause mortality events in all subgroups during long term follow-up.

Original languageEnglish (US)
JournalJournal of Diabetes and its Complications
DOIs
StatePublished - Jan 1 2019

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Shaikh, K., Li, D., Nakanishi, R., Kinninger, A., Almeida, S., Cherukuri, L., Shekar, C., Roy, S. K., Birudaraju, D., Rai, K., Ahmad, K., Shafter, A., Kumar, A., Hamal, S., Alla, V. M., & Budoff, M. J. (2019). Low short-term and long-term cardiovascular and all-cause mortality in absence of coronary artery calcium: A 22-year follow-up observational study from large cohort. Journal of Diabetes and its Complications. https://doi.org/10.1016/j.jdiacomp.2019.05.015