Coronary Artery Calcium Scores in Older Adults With Diabetes and Their Association With Diabetes-Specific Risk Enhancers (from the Atherosclerosis Risk in Communities Study)

Coronary artery calcium (CAC) is a validated marker of atherosclerotic cardiovascular disease (ASCVD) risk; however, it is not routinely incorporated in ASCVD risk prediction in older adults with diabetes. We sought to assess the CAC distribution among this demo-graphic and its association with diabetes-specific risk enhancers, which are known to be associated with increased ASCVD risk. We used the ARIC (Atherosclerosis Risk in Com-munities) study data, including adults aged >75 years with diabetes, who had their CAC measured at ARIC visit 7 (2018 to 2019). The demographic characteristics of participants and their CAC distribution were analyzed using descriptive statistics. Multivariable-adjusted logistic regression models were used to estimate the association between diabe-tes-specific risk enhancers (duration of diabetes, albuminuria, chronic kidney disease, reti-nopathy, neuropathy, and ankle-brachial index) and elevated CAC, adjusting for age, gender, race, education level, dyslipidemia, hypertension, physical activity, smoking sta-tus, and family history of coronary heart disease. The mean age in our sample was 79.9 (SD 3.97) years, with 56.6% women and 62.1% White. The CAC scores were heteroge-nous, and the median CAC score was higher in participants with a greater number of dia-betes risk enhancers, regardless of gender. In the multivariable-adjusted logistic regression models, participants with & GE;2 diabetes-specific risk enhancers had greater odds of elevated CAC than those with <2 (odds ratio 2.31, 95% confidence interval 1.34 to 3.98). In conclusion, the distribution of CAC was heterogeneous among older adults with diabetes, with the CAC burden associated with the number of diabetes risk-enhancing factors present. These data may have implications for prognostication in older patients with diabetes and supports the possible incorporation of CAC in the assessment of cardio-vascular disease risk in this population. & COPY; 2023 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;201:219-223)

Automated summary

The distribution of coronary artery calcium (CAC) was found to be associated with diabetes-specific risk enhancers among older adults with diabetes, indicating an increased risk of atherosclerotic cardiovascular disease (ASCVD). These findings have important implications for prognostication in diabetes patients and support the incorporation of CAC in the assessment of cardiovascular disease risk in this population.