Coronary artery calcium, hepatic steatosis, and atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus: Results from the Dallas heart study
Section snippets
Study population
DHS is a multi-ethnic, cohort study of Dallas County residents with oversampling of African Americans with the goal of improving the diagnosis, prevention, and treatment of heart disease. Details of the study have been described previously.10 From an overall cohort of 3072 participants with imaging, individuals with prevalent self-reported history of ASCVD (N = 80), heart failure (N = 62), or cardiac arrest (N = 6) or those with a history of excessive alcohol consumption (N = 178) were
Results
A total of 1252 DHS participants were included, of which 122 (9.7%) had T2D. The median age was 45 ± 15 years, median body mass index (BMI)was 27.80 ± 7.54 kg/m2, 55.2% were female, and 58.9% were Black. CAC scores were higher amongst those with T2D (median 2.65 ± 40.51 vs 0 ± 4.30, p < 0.01). Amongst those with T2D, 68 (55.7%) had HS; whereas amongst those without T2D, the prevalence of HS was 27.3% (p < 0.01 compared with T2D, Table 1). There was no significant difference in the age or the
Discussion
In this study of 1252 DHS participants, approximately 10% of participants had T2D. The prevalence of HS was higher amongst those with T2D than without T2D. Similarly, the ASCVD event rate was higher in those with T2D. There was a significant association between continuous CAC with incident ASCVD regardless of T2D or HS status. When CAC was assessed as a categorical variable CAC ≥ 100, but not CAC > 0, was associated with ASCVD in participants with T2D, but this relationship was no longer
Limitations
There are a number of limitations associated with this study. The baseline characteristics of the groups compared were significantly different in a number of ways, including baseline lipid profiles, gender, BMI, and blood pressure/antihypertensive use. Given the known association of these clinical characteristics with ASCVD outcomes, our results were likely influenced by these factors and potential unmeasured confounders. However, our results were adjusted for many of these factors, including
Conclusions
In this analysis of the DHS, we observed a consistent association between continuous CAC and ASCVD outcomes in all groups, with a more nuanced association between categorical CAC and ASCVD amongst those with T2D and those with HS. A significant interaction between both CAC and HTC with T2D status on ASCVD outcomes was observed, with a strong inverse association between HTC and ASCVD outcomes in those with T2D. These findings reinforce the known important association between CAC and ASCVD
Disclosures
Jennifer Linge is an employee at AMRA Medical AB. The remaining authors have no disclosures.
Funding
Supported in part by grant UL1TR001105 from the National Center for Advancing Translational Sciences, National Institutes of Health.
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