TY - JOUR
T1 - Cardiovascular Risk Heterogeneity in Adults with Diabetes
T2 - Selective Use of Coronary Artery Calcium in Statin Use Decision-making
AU - Sarkar, Sudipa
AU - Orimoloye, Olusola A.
AU - Nass, Caitlin M.
AU - Blumenthal, Roger S.
AU - Martin, Seth S.
N1 - Funding Information:
SSM has no disclosures specifically related to coronary artery calcium imaging. He has received personal fees for serving on scientific advisory boards for Amgen, Sanofi/Regeneron, Quest Diagnostics, Esperion, Akcea Therapeutics, and Novo Nordisk. He reports grants/research support from the NIH, PJ Schafer Cardiovascular Research Fund, the David and June Trone Family Foundation, American Heart Association, Aetna Foundation, Maryland Innovation Initiative, Nokia, Google, and Apple; in addition, he is listed as a co-inventor on a patent application pending on a method of LDL-C estimation. All remaining authors declare that they do not have a conflict of interest.
Publisher Copyright:
© 2019, Society of General Internal Medicine.
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Current American College of Cardiology/American Heart Association and American Diabetes Association guidelines recommend statin therapy for all patients with diabetes between the ages of 40 and 75, including those without cardiovascular disease (CVD). While diabetes is a major CVD risk factor, not all patients with diabetes have an equal risk of CVD. Thus, a more risk-based approach warrants consideration when recommending statin therapy for the primary prevention of CVD. Coronary artery calcium (CAC) is a noninvasive imaging modality that can help risk stratify patients with diabetes for future CVD events. CAC has been extensively studied in large cohorts such as the Multi-Ethnic Study of Atherosclerosis and found to outperform other novel risk stratification tools including carotid intima-media thickness. Moreover, a CAC score of 0 has been shown to be useful in downgrading the estimated risk of a CVD event in patients with diabetes and an intermediate Pooled Cohort Equation score. As clinicians weigh the recommendation for a lifelong therapy and the problem of statin nonadherence and patients weigh concerns about adverse effects of statins, the decision to initiate statin therapy in patients with diabetes is ideally a shared one between patients and providers, and CAC could facilitate this discussion.
AB - Current American College of Cardiology/American Heart Association and American Diabetes Association guidelines recommend statin therapy for all patients with diabetes between the ages of 40 and 75, including those without cardiovascular disease (CVD). While diabetes is a major CVD risk factor, not all patients with diabetes have an equal risk of CVD. Thus, a more risk-based approach warrants consideration when recommending statin therapy for the primary prevention of CVD. Coronary artery calcium (CAC) is a noninvasive imaging modality that can help risk stratify patients with diabetes for future CVD events. CAC has been extensively studied in large cohorts such as the Multi-Ethnic Study of Atherosclerosis and found to outperform other novel risk stratification tools including carotid intima-media thickness. Moreover, a CAC score of 0 has been shown to be useful in downgrading the estimated risk of a CVD event in patients with diabetes and an intermediate Pooled Cohort Equation score. As clinicians weigh the recommendation for a lifelong therapy and the problem of statin nonadherence and patients weigh concerns about adverse effects of statins, the decision to initiate statin therapy in patients with diabetes is ideally a shared one between patients and providers, and CAC could facilitate this discussion.
KW - cardiovascular disease
KW - coronary artery calcium
KW - diabetes
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U2 - 10.1007/s11606-019-05266-2
DO - 10.1007/s11606-019-05266-2
M3 - Article
C2 - 31414361
AN - SCOPUS:85071167567
SN - 0884-8734
VL - 34
SP - 2643
EP - 2647
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 11
ER -