MEDIAL ARTERY CALCIFICATION - A NEGLECTED HARBINGER OF CARDIOVASCULARCOMPLICATIONS IN NON-INSULIN-DEPENDENT DIABETES-MELLITUS

Medial artery calcification (MAC) is a nonobstructive condition leadin g to reduced arterial compliance that is commonly considered as a nons ignificant finding. The aim of our study was to investigate the predic tive value of MAC in relation to 7-year cardiovascular mortality, coro nary heart disease (CHD) events, stroke, and lower extremity amputatio n in 1059 patients (581 men and 478 women) with non-insulin-dependent diabetes mellitus (NIDDM). At baseline radiologically detectable MAC i n femoral. arteries was found in 439 patients (41.5%) and intimal-type calcification in 310 diabetic patients (29.3%). The mean fasting plas ma glucose at baseline was somewhat higher in women and the duration o f diabetes somewhat longer in patients with MAC than in those without, but otherwise the presence of MAC was unrelated to conventional cardi ovascular risk factors. During the follow-up 305 diabetic patients die d: 208 from cardiovascular disease, 158 from CHD, and 34 from stroke. Furthermore, 58 NIDDM patients underwent their first lower extremity a mputation. MAC was a strong independent predictor of total (risk facto r-adjusted odds ratio and 95% confidence interval: 1.6; 1.2, 2.2), car diovascular (1.6; 1.1, 2.2), and CHD (1.5; 1.0, 2.2) mortality, and it was also a significant predictor of future CHD events (fatal or nonfa tal myocardial infarction), stroke, and amputation. This relationship was observed regardless of glycemic control and known duration of NIDD M. MAC is a strong marker of future cardiovascular events in NIDDM unr elated to cardiovascular risk factors, supporting the hypothesis that reduced arterial elasticity could lead to clinical manifestations of d iabetic macroangiopathy.