Impact of Subclinical Atherosclerosis on Cardiovascular Disease Events in Individuals With Metabolic Syndrome and Diabetes
The Multi-Ethnic Study of Atherosclerosis
- Shaista Malik, MD, PHD1,
- Matthew J. Budoff, MD2,
- Ronit Katz, PHD3,
- Roger S. Blumenthal, MD4,
- Alain G. Bertoni, MD, MPH5,
- Khurram Nasir, MD4,
- Moyses Szklo, MD6,
- R. Graham Barr, MD7 and
- Nathan D. Wong, PHD1⇓
- 1Heart Disease Prevention Program, Division of Cardiology, University of California–Irvine, Irvine, California
- 2Los Angeles Biomedical Research Institute, Harbor–UCLA Medical Center, Los Angeles, California
- 3University of Washington, Seattle, Washington
- 4Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland
- 5Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston–Salem, North Carolina
- 6Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
- 7Department of Medicine, Columbia University, New York, New York
- Corresponding author: Nathan D. Wong, .
OBJECTIVE While metabolic syndrome (MetS) and diabetes confer greater cardiovascular disease (CVD) risk, recent evidence suggests that individuals with these conditions have a wide range of risk. We evaluated whether screening for coronary artery calcium (CAC) and carotid intimal-medial thickness (CIMT) can improve CVD risk stratification over traditional risk factors (RFs) in people with MetS and diabetes.
RESEARCH DESIGN AND METHODS We assessed CAC and CIMT in 6,603 people aged 45–84 years in the Multi-Ethnic Study of Atherosclerosis (MESA). Cox regression examined the association of CAC and CIMT with coronary heart disease (CHD) and CVD over 6.4 years in MetS and diabetes.
RESULTS Of the subjects, 1,686 (25%) had MetS but no diabetes and 881 (13%) had diabetes. Annual CHD event rates were 1.0% among MetS and 1.5% for diabetes. Ethnicity and RF-adjusted hazard ratios for CHD for CAC 1–99 to ≥400 vs. 0 in subjects with neither MetS nor diabetes ranged from 2.6 to 9.5; in those with MetS, they ranged from 3.9 to 11.9; and in those with diabetes, they ranged from 2.9 to 6.2 (all P < 0.05 to P < 0.001). Findings were similar for CVD. CAC increased the C-statistic for events (P < 0.001) over RFs and CIMT in each group while CIMT added negligibly to prediction over RFs.
CONCLUSIONS Individuals with MetS or diabetes have low risks for CHD when CAC or CIMT is not increased. Prediction of CHD and CVD events is improved by CAC more than by CIMT. Screening for CAC or CIMT can stratify risk in people with MetS and diabetes and support the latest recommendations regarding CAC screening in those with diabetes.
- Received April 30, 2011.
- Accepted July 1, 2011.
- © 2011 by the American Diabetes Association.
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