Metabolic syndrome, diabetes, and incidence and progression of coronary calcium: The multiethnic study of atherosclerosis study

Nathan D. Wong, Jennifer C. Nelson, Tanya Granston, Alain G. Bertoni, Roger S Blumenthal, J. Jeffrey Carr, Alan Guerci, David R. Jacobs, Richard Kronmal, Kiang Liu, Mohammed Saad, Elizabeth Selvin, Russell Tracy, Robert Detrano

Research output: Contribution to journalArticle

Abstract

Objectives: This study sought to examine and compare the incidence and progression of coronary artery calcium (CAC) among persons with metabolic syndrome (MetS) and diabetes mellitus (DM) versus those with neither condition. Background: MetS and DM are associated with subclinical atherosclerosis as evidenced by CAC. Methods: The MESA (Multiethnic Study of Atherosclerosis) included 6,814 African American, Asian, Caucasian, and Hispanic adults 45 to 84 years of age, who were free of cardiovascular disease at baseline. Of these, 5,662 subjects (51% women, mean age 61.0 ± 10.3 years) received baseline and follow-up (mean 2.4 years) cardiac computed tomography scans. We compared the incidence of CAC in 2,927 subjects without CAC at baseline and progression of CAC in 2,735 subjects with CAC at baseline in those with MetS without DM (25.2%), DM without MetS (3.5%), or both DM and MetS (9.0%) to incidence and progression in subjects with neither MetS nor DM (58%). Progression of CAC was also examined in relation to coronary heart disease events over an additional 4.9 years. Results: Relative to those with neither MetS nor DM, adjusted relative risks (95% confidence intervals [CI]) for incident CAC were 1.7 (95% CI: 1.4 to 2.0), 1.9 (95% CI: 1.4 to 2.4), and 1.8 (95% CI: 1.4 to 2.2) (all p <0.01), and absolute differences in mean progression (volume score) were 7.8 (95% CI: 4.0 to 11.6; p <0.01), 11.6 (95% CI: 2.7 to 20.5; p <0.05), and 22.6 (95% CI: 17.2 to 27.9; p <0.01) for those with MetS without DM, DM without MetS, and both DM and MetS, respectively. Similar findings were seen in analysis using Agatston calcium score. In addition, progression predicted coronary heart disease events in those with MetS without DM (adjusted hazard ratio: 4.1, 95% CI: 2.0 to 8.5, p <0.01) and DM (adjusted hazard ratio: 4.9 [95% CI: 1.3 to 18.4], p <0.05) among those in the highest tertile of CAC increase versus no increase. Conclusions: Individuals with MetS and DM have a greater incidence and absolute progression of CAC compared with individuals without these conditions, with progression also predicting coronary heart disease events in those with MetS and DM.

Original languageEnglish (US)
Pages (from-to)358-366
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume5
Issue number4
DOIs
StatePublished - Apr 2012

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Atherosclerosis
Diabetes Mellitus
Calcium
Coronary Vessels
Incidence
Confidence Intervals
Coronary Disease
Hispanic Americans
African Americans
Cardiovascular Diseases
Tomography

Keywords

  • atherosclerosis
  • calcification
  • diabetes
  • risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Metabolic syndrome, diabetes, and incidence and progression of coronary calcium : The multiethnic study of atherosclerosis study. / Wong, Nathan D.; Nelson, Jennifer C.; Granston, Tanya; Bertoni, Alain G.; Blumenthal, Roger S; Carr, J. Jeffrey; Guerci, Alan; Jacobs, David R.; Kronmal, Richard; Liu, Kiang; Saad, Mohammed; Selvin, Elizabeth; Tracy, Russell; Detrano, Robert.

In: JACC: Cardiovascular Imaging, Vol. 5, No. 4, 04.2012, p. 358-366.

Research output: Contribution to journalArticle

Wong, ND, Nelson, JC, Granston, T, Bertoni, AG, Blumenthal, RS, Carr, JJ, Guerci, A, Jacobs, DR, Kronmal, R, Liu, K, Saad, M, Selvin, E, Tracy, R & Detrano, R 2012, 'Metabolic syndrome, diabetes, and incidence and progression of coronary calcium: The multiethnic study of atherosclerosis study', JACC: Cardiovascular Imaging, vol. 5, no. 4, pp. 358-366. https://doi.org/10.1016/j.jcmg.2011.12.015
Wong, Nathan D. ; Nelson, Jennifer C. ; Granston, Tanya ; Bertoni, Alain G. ; Blumenthal, Roger S ; Carr, J. Jeffrey ; Guerci, Alan ; Jacobs, David R. ; Kronmal, Richard ; Liu, Kiang ; Saad, Mohammed ; Selvin, Elizabeth ; Tracy, Russell ; Detrano, Robert. / Metabolic syndrome, diabetes, and incidence and progression of coronary calcium : The multiethnic study of atherosclerosis study. In: JACC: Cardiovascular Imaging. 2012 ; Vol. 5, No. 4. pp. 358-366.
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abstract = "Objectives: This study sought to examine and compare the incidence and progression of coronary artery calcium (CAC) among persons with metabolic syndrome (MetS) and diabetes mellitus (DM) versus those with neither condition. Background: MetS and DM are associated with subclinical atherosclerosis as evidenced by CAC. Methods: The MESA (Multiethnic Study of Atherosclerosis) included 6,814 African American, Asian, Caucasian, and Hispanic adults 45 to 84 years of age, who were free of cardiovascular disease at baseline. Of these, 5,662 subjects (51{\%} women, mean age 61.0 ± 10.3 years) received baseline and follow-up (mean 2.4 years) cardiac computed tomography scans. We compared the incidence of CAC in 2,927 subjects without CAC at baseline and progression of CAC in 2,735 subjects with CAC at baseline in those with MetS without DM (25.2{\%}), DM without MetS (3.5{\%}), or both DM and MetS (9.0{\%}) to incidence and progression in subjects with neither MetS nor DM (58{\%}). Progression of CAC was also examined in relation to coronary heart disease events over an additional 4.9 years. Results: Relative to those with neither MetS nor DM, adjusted relative risks (95{\%} confidence intervals [CI]) for incident CAC were 1.7 (95{\%} CI: 1.4 to 2.0), 1.9 (95{\%} CI: 1.4 to 2.4), and 1.8 (95{\%} CI: 1.4 to 2.2) (all p <0.01), and absolute differences in mean progression (volume score) were 7.8 (95{\%} CI: 4.0 to 11.6; p <0.01), 11.6 (95{\%} CI: 2.7 to 20.5; p <0.05), and 22.6 (95{\%} CI: 17.2 to 27.9; p <0.01) for those with MetS without DM, DM without MetS, and both DM and MetS, respectively. Similar findings were seen in analysis using Agatston calcium score. In addition, progression predicted coronary heart disease events in those with MetS without DM (adjusted hazard ratio: 4.1, 95{\%} CI: 2.0 to 8.5, p <0.01) and DM (adjusted hazard ratio: 4.9 [95{\%} CI: 1.3 to 18.4], p <0.05) among those in the highest tertile of CAC increase versus no increase. Conclusions: Individuals with MetS and DM have a greater incidence and absolute progression of CAC compared with individuals without these conditions, with progression also predicting coronary heart disease events in those with MetS and DM.",
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T1 - Metabolic syndrome, diabetes, and incidence and progression of coronary calcium

T2 - The multiethnic study of atherosclerosis study

AU - Wong, Nathan D.

AU - Nelson, Jennifer C.

AU - Granston, Tanya

AU - Bertoni, Alain G.

AU - Blumenthal, Roger S

AU - Carr, J. Jeffrey

AU - Guerci, Alan

AU - Jacobs, David R.

AU - Kronmal, Richard

AU - Liu, Kiang

AU - Saad, Mohammed

AU - Selvin, Elizabeth

AU - Tracy, Russell

AU - Detrano, Robert

PY - 2012/4

Y1 - 2012/4

N2 - Objectives: This study sought to examine and compare the incidence and progression of coronary artery calcium (CAC) among persons with metabolic syndrome (MetS) and diabetes mellitus (DM) versus those with neither condition. Background: MetS and DM are associated with subclinical atherosclerosis as evidenced by CAC. Methods: The MESA (Multiethnic Study of Atherosclerosis) included 6,814 African American, Asian, Caucasian, and Hispanic adults 45 to 84 years of age, who were free of cardiovascular disease at baseline. Of these, 5,662 subjects (51% women, mean age 61.0 ± 10.3 years) received baseline and follow-up (mean 2.4 years) cardiac computed tomography scans. We compared the incidence of CAC in 2,927 subjects without CAC at baseline and progression of CAC in 2,735 subjects with CAC at baseline in those with MetS without DM (25.2%), DM without MetS (3.5%), or both DM and MetS (9.0%) to incidence and progression in subjects with neither MetS nor DM (58%). Progression of CAC was also examined in relation to coronary heart disease events over an additional 4.9 years. Results: Relative to those with neither MetS nor DM, adjusted relative risks (95% confidence intervals [CI]) for incident CAC were 1.7 (95% CI: 1.4 to 2.0), 1.9 (95% CI: 1.4 to 2.4), and 1.8 (95% CI: 1.4 to 2.2) (all p <0.01), and absolute differences in mean progression (volume score) were 7.8 (95% CI: 4.0 to 11.6; p <0.01), 11.6 (95% CI: 2.7 to 20.5; p <0.05), and 22.6 (95% CI: 17.2 to 27.9; p <0.01) for those with MetS without DM, DM without MetS, and both DM and MetS, respectively. Similar findings were seen in analysis using Agatston calcium score. In addition, progression predicted coronary heart disease events in those with MetS without DM (adjusted hazard ratio: 4.1, 95% CI: 2.0 to 8.5, p <0.01) and DM (adjusted hazard ratio: 4.9 [95% CI: 1.3 to 18.4], p <0.05) among those in the highest tertile of CAC increase versus no increase. Conclusions: Individuals with MetS and DM have a greater incidence and absolute progression of CAC compared with individuals without these conditions, with progression also predicting coronary heart disease events in those with MetS and DM.

AB - Objectives: This study sought to examine and compare the incidence and progression of coronary artery calcium (CAC) among persons with metabolic syndrome (MetS) and diabetes mellitus (DM) versus those with neither condition. Background: MetS and DM are associated with subclinical atherosclerosis as evidenced by CAC. Methods: The MESA (Multiethnic Study of Atherosclerosis) included 6,814 African American, Asian, Caucasian, and Hispanic adults 45 to 84 years of age, who were free of cardiovascular disease at baseline. Of these, 5,662 subjects (51% women, mean age 61.0 ± 10.3 years) received baseline and follow-up (mean 2.4 years) cardiac computed tomography scans. We compared the incidence of CAC in 2,927 subjects without CAC at baseline and progression of CAC in 2,735 subjects with CAC at baseline in those with MetS without DM (25.2%), DM without MetS (3.5%), or both DM and MetS (9.0%) to incidence and progression in subjects with neither MetS nor DM (58%). Progression of CAC was also examined in relation to coronary heart disease events over an additional 4.9 years. Results: Relative to those with neither MetS nor DM, adjusted relative risks (95% confidence intervals [CI]) for incident CAC were 1.7 (95% CI: 1.4 to 2.0), 1.9 (95% CI: 1.4 to 2.4), and 1.8 (95% CI: 1.4 to 2.2) (all p <0.01), and absolute differences in mean progression (volume score) were 7.8 (95% CI: 4.0 to 11.6; p <0.01), 11.6 (95% CI: 2.7 to 20.5; p <0.05), and 22.6 (95% CI: 17.2 to 27.9; p <0.01) for those with MetS without DM, DM without MetS, and both DM and MetS, respectively. Similar findings were seen in analysis using Agatston calcium score. In addition, progression predicted coronary heart disease events in those with MetS without DM (adjusted hazard ratio: 4.1, 95% CI: 2.0 to 8.5, p <0.01) and DM (adjusted hazard ratio: 4.9 [95% CI: 1.3 to 18.4], p <0.05) among those in the highest tertile of CAC increase versus no increase. Conclusions: Individuals with MetS and DM have a greater incidence and absolute progression of CAC compared with individuals without these conditions, with progression also predicting coronary heart disease events in those with MetS and DM.

KW - atherosclerosis

KW - calcification

KW - diabetes

KW - risk factors

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