Original Research
Predicting Long-Term Absence of Coronary Artery Calcium in Metabolic Syndrome and Diabetes: The MESA Study

https://doi.org/10.1016/j.jcmg.2020.06.047Get rights and content
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Abstract

Objectives

The purpose of this study was to identify predictors of healthy arterial aging (long-term coronary artery calcification [CAC] of 0) among individuals with metabolic syndrome (MetS) or type 2 diabetes (T2D), which may improve primary prevention strategies.

Background

Individuals with MetS or T2D have a heterogeneously increased risk of atherosclerotic cardiovascular disease and not all have a high-intermediate risk.

Methods

We included 574 participants from the MESA (Multi-Ethnic Study of Atherosclerosis) with MetS or T2D who had CAC=0 at baseline and a repeat CAC scan 10 years later. Multivariable logistic regression assessed the association of traditional and novel atherosclerotic cardiovascular disease risk factors and the MetS severity score (based on the 5 MetS criteria) with healthy arterial aging.

Results

The mean age of participants was 58.9 years, 67% were women, 422 participants had MetS, and 152 had T2D. The proportion with long-term CAC=0 was similar for MetS (42%) and T2D (44%). A younger age was the only individual low/normal traditional risk factor associated with an increased likelihood of long-term CAC=0 (odds ratio [OR]: 1.50; 95% confidence interval [CI]: 1.22 to 1.85 per 10-years younger). The strongest associations of nontraditional risk factors were observed for an absence of thoracic calcification (OR: 2.42; 95% CI: 1.24 to 4.72), absence of carotid plaque (OR: 1.81; 95% CI: 1.25 to 2.61), and among persons with a high sensitivity troponin <3 ng/ml (OR: 1.55; 95% CI: 1.01 to 2.38). In addition, persons with the lowest quartile MetS severity score had a substantially higher odds of healthy long-term CAC=0 (OR: 2.71; 95% CI: 1.27 to 5.76).

ConclusionS

More than 40% of adults with MetS or T2D and baseline CAC=0 had long-term absence of CAC, which was most strongly associated with an absence of extracoronary atherosclerosis and a low MetS score. An optimal overall cardiovascular profile appears to be more important than an ideal value of any individual risk factor to maintain healthy arterial aging.

Key Words

aging
atherosclerosis
cardiovascular diseases
coronary artery calcium
diabetes mellitus
type 2
healthy lifestyle
metabolic syndrome
multidetector computed tomography
prevention
risk

Abbreviations and Acronyms

ASCVD
atherosclerotic cardiovascular disease
CAC
coronary artery calcification
CI
confidence interval
hs-cTnT
high-sensitivity cardiac troponin T
eGFR
estimated glomerular filtration rate
HDL-C
high-density lipoprotein cholesterol
Lp(a)
lipoprotein a
MetS
metabolic syndrome
NT-proBNP
N-terminal pro-brain natriuretic peptide
OR
odds ratio
PCE
Pooled Cohort Equations
T2D
type 2 diabetes

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