Prevalence, determinants and prognostic value of high coronary artery calcium score in asymptomatic patients with diabetes: A systematic review and meta-analysis

Background: The pharmacological management of diabetes is mostly based on its cardiovascular risk assessment. For this purpose, coronary artery calcium score (CACS) is proposed with a soft (class IIb) recommendation, as its prognostic implication requires further evidence in different subsets. Thus, we carried-out a systematic review and meta-analysis to address the prevalence of high CACS, its determinants and prognostic value in asymp-tomatic patients with diabetes, with a special focus on different sex and ethnic groups. Methods: We carried out a systematic review of the published literature in several databases between 01/2000 and 01/2021. Original studies were included if they presented data on the prevalence, determinants and prognosis of high CACS in patients with diabetes without known cardiovascular disease. Using random effects models, we calculated pooled odds ratios (OR) for CACS determinants and Relative Risk (RR) for CACS prog-nostic value on all-cause mortality and/or fatal and non-fatal CV events in different categories.Results: We included 23 studies (n = 20,999 patients). Female sex and black ethnicity presented the lowest prevalence of CACS > 0. Age, male sex, non-black ethnicity and diabetes duration were identified as risk factors for high CACS. Among the 10 studies (n = 110,396 person-years) with prognostic data, the pooled RR for the occurrence of all-cause death and/or cardiovascular events were 4.03 (95%CI: 3.04-5.34), 5.87 (95%CI: 4.32-7.99) and 9.04 (95%CI: 5.81-14.06) respectively for CACS > 0 vs. CACS = 0, CACS & GE;100 vs. CACS < 10 and CACS & GE;400 vs. CACS < 10. For similar CACS, these RR were greater in women than in men.Conclusion: Our meta-analysis demonstrates that the increase in CACS is strongly associated with an increased risk for all-cause mortality and/or fatal and non-fatal CV events in asymptomatic patients with diabetes.

Automated summary

This study systematically reviewed and meta-analyzed the prevalence, determinants, and prognostic value of coronary artery calcium score (CACS) in asymptomatic patients with diabetes, finding that age, male sex, non-black ethnicity, and diabetes duration were risk factors for high CACS. An increase in CACS was strongly associated with an increased risk for all-cause mortality and/or fatal and non-fatal cardiovascular events, with women potentially having a higher risk than men.