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Extensive evidence shows that diabetes mellitus (DM) and smoking (SM) amplify the risk of cardiovascular disease. In the current study we evaluated the effect of combined DM/smoking status and its interplay with burden of coronary artery calcium(CAC) on risk of all-cause mortality.
The study cohort consisted of 44,052 (54±10 years, 54% men) consecutive asymptomatic individuals free of known coronary heart disease referred for CAC testing to improve risk assessment. Individuals were grouped as follows (DM(−)/SM (−), n=36,216 82%), (DM(−)/SM (+), n=5,448, 13%), (DM(+)/SM (−), n=1,816 4%), (DM(+)/SM (+), n=572, 1%).
Overall 901 deaths (2.05%) were recorded during a mean follow-up of 5.6 ± 2.6 years. When stratified according to CAC scores (figure), the lowest fatality rate was observed in patients with no CAC and DM(−)/SM (−), whereas those with CAC>400 and (DM(+)/SM (+) had the highest all-cause fatality rate. In multivariable analyses adjusting for CAC and other risk factors, as compared to DM (−)/SM (−), the HR for all-cause mortality among smokers alone, diabetics alone and both conditions were 3.44 (2.89-4.10), 2.52 (2.02-3.13) and 5.04 (3.67-6.93).
The combination of smoking and DM is associated with significantly higher risk of death across the entire spectrum of subclinical coronary atherosclerosis.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Imaging: CT/Multimodality VI
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1230-368
- 2013 American College of Cardiology Foundation