Author + information
- Received February 19, 2007
- Revision received August 23, 2007
- Accepted August 27, 2007
- Published online December 4, 2007.
- Dhakshinamurthy Vijay Anand, MBBS, MRCP⁎,†,⁎ (, )
- Eric Lim, MBChB, MA, MRCP⁎,
- Daniel Darko, MD, MRCP‡,
- Paul Bassett, MSc§,
- David Hopkins, BSc, MBChB, FRCP∥,
- David Lipkin, BSc, MD, FRCP⁎,¶,
- Roger Corder, PhD, MRPharmS† and
- Avijit Lahiri, MBBS, MSc, MRCP, FACC, FESC⁎
- ↵⁎Reprint requests and correspondence:
Dr. Dhakshinamurthy Vijay Anand, Cardiac Imaging and Research Centre, Wellington Hospital (South), Wellington Place, St. John’s Wood, London, NW8 9LE, United Kingdom.
Objectives This study prospectively evaluated the relationship between cardiovascular risk factors, selected biomarkers (high-sensitivity C-reactive protein [hs-CRP], interleukin [IL]-6, and osteoprotegerin [OPG]), and the progression of coronary artery calcification (CAC) in type 2 diabetic subjects.
Background Coronary artery calcification is pathognomonic of coronary atherosclerosis. Osteoprotegerin is a signaling molecule involved in bone remodeling that has been implicated in the regulation of vascular calcification and atherogenesis.
Methods Three hundred ninety-eight type 2 diabetic subjects without prior coronary disease or symptoms (age 52 ± 8 years, 61% male, glycated hemoglobin [HbA1c] 8 ± 1.5) were evaluated serially by CAC imaging (mean follow-up 2.5 ± 0.4 years). Progression/regression of CAC was defined as a change ≥2.5 between the square root transformed values of baseline and follow-up volumetric CAC scores. Demographic data, risk factors, glycemic control, medication use, serum hs-CRP, IL-6, and plasma OPG levels were measured at baseline and follow-up.
Results Two hundred eleven patients (53%) had CAC at baseline. One hundred eighteen patients (29.6%) had CAC progression, whereas 3 patients (0.8%) had regression. Age, male gender, hypertension, baseline CAC, HbA1c >7, waist-hip ratio, IL-6, OPG, use of beta-blockers, calcium channel antagonists, angiotensin-converting enzyme (ACE) inhibitors, statins, and Framingham/UKPDS (United Kingdom Prospective Diabetes Study) risk scores were univariable predictors of CAC progression. In the multivariate model, baseline CAC (odds ratio [OR] for CAC >400 = 6.38, 95% confidence interval [CI] 2.63 to 15.5, p < 0.001), HbA1c >7 (OR 1.95, CI 1.08 to 3.52, p = 0.03), and statin use (OR 2.27, CI 1.38 to 3.73, p = 0.001) were independent predictors of CAC progression.
Conclusions Baseline CAC severity and suboptimal glycemic control are strong risk factors for CAC progression in type 2 diabetic subjects.
This study was supported by the Derrick Smith/Harrow Cardiovascular Trust research grant.
- Received February 19, 2007.
- Revision received August 23, 2007.
- Accepted August 27, 2007.
- American College of Cardiology Foundation