Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles School of Medicine, Torrance, California.
Department of Biostatistics, George Washington University, Rockville, Maryland.
JACC Cardiovasc Imaging. 2019 Jul;12(7 Pt 2):1341-1349. doi: 10.1016/j.jcmg.2019.01.014. Epub 2019 Mar 13.
This study sought to determine the relationship between coronary artery calcium (CAC) scores and subsequent cardiovascular disease (CVD) events in DCCT (Diabetes Control and Complications Trial)/EDIC (Epidemiology of Diabetes Interventions and Complications) participants.
The CAC score has been validated for improved risk stratification in general populations; however, this association has not been well studied in type 1 diabetes (T1DM).
Computed tomography (CT) to measure CAC was performed in 1,205 DCCT/EDIC participants at a mean of 42.8 years of age during EDIC years 7 to 9, after the end of DCCT. This study analyzed the association between CAC and time to the first subsequent CVD event or to the first major adverse cardiac event (MACE), a follow-up of 10 to 13 years. CAC was categorized as: 0, >0 to 100, >100 to 300, or >300 Agatston units.
Of 1,156 participants at risk for subsequent CVD, 105 had an initial CVD event (8.5 per 1,000 patient-years); and of 1,187 participants at risk for MACE, 51 had an initial MACE event (3.9 per 1,000 patient-years). Event rates among those with scores of zero (n = 817 [70.7%]) were very low for CVD (5.6 per 1,000 patient years). CAC scores >100 to 300 (hazard ratio [HR]: 4.17, 5.40) and >300 (HR: 6.06, 6.91) were associated with higher risks of CVD and MACE, respectively, compared to CAC of 0 (p < 0.0001). CAC scores >0 to 100 were nominally associated with CVD (HR: 1.71; p = 0.0415) but not with MACE (HR: 1.11; p = 0.8134). Similar results were observed when also adjusted for mean HbA and conventional CVD risk factors. The increment in the AUC due to CAC was modest.
CAC scores >100 Agatston units were significantly associated with an increased risk of the subsequent occurrence of CVD and MACE in DCCT/EDIC cohort. (Diabetes Control and Complications Trial [DCCT]; NCT00360815; Epidemiology of Diabetes Interventions and Complications [EDIC]; NCT00360893).
本研究旨在探讨冠状动脉钙（CAC）评分与 DCCT（糖尿病控制和并发症试验）/EDIC（糖尿病干预和并发症的流行病学）参与者随后发生心血管疾病（CVD）事件之间的关系。
CAC 评分已被验证可改善一般人群的风险分层；然而，在 1 型糖尿病（T1DM）中，这种关联尚未得到很好的研究。
在 EDIC 第 7 至 9 年期间，即 DCCT 结束后，1,205 名 DCCT/EDIC 参与者进行了计算机断层扫描（CT）以测量 CAC，平均年龄为 42.8 岁。本研究分析了 CAC 与首次随后 CVD 事件或首次主要不良心脏事件（MACE）之间的时间关系，随访时间为 10 至 13 年。CAC 分为：0、>0 至 100、>100 至 300、或>300 阿加斯顿单位。
在有发生 CVD 风险的 1,156 名参与者中，有 105 名发生了初始 CVD 事件（每 1,000 名患者年 8.5 例）；在有发生 MACE 风险的 1,187 名参与者中，有 51 名发生了初始 MACE 事件（每 1,000 名患者年 3.9 例）。CAC 评分为零（n=817[70.7%]）的患者发生 CVD 的发生率非常低（每 1,000 患者年 5.6 例）。CAC 评分>100 至 300（HR：4.17，5.40）和>300（HR：6.06，6.91）与 CVD 和 MACE 的风险增加分别相关，与 CAC 评分为 0 相比（p<0.0001）。CAC 评分>0 至 100 与 CVD 呈名义相关（HR：1.71；p=0.0415），但与 MACE 无关（HR：1.11；p=0.8134）。当也调整平均 HbA 和传统 CVD 危险因素时，也观察到类似的结果。由于 CAC 导致 AUC 的增加幅度较小。
CAC 评分>100 阿加斯顿单位与 DCCT/EDIC 队列中随后发生 CVD 和 MACE 的风险增加显著相关。（糖尿病控制和并发症试验 [DCCT]；NCT00360815；糖尿病干预和并发症的流行病学 [EDIC]；NCT00360893）。
