Increased prevalence of significant coronary artery calcification in patients with diabetes

OBJECTIVE- Coronary artery disease is the major cause of morbidity and mort ality in patients with diabetes. Detection of coronary artery disease befor e the first myocardial infarction and before anginal symptoms will allow fo r strategies designed to reduce the cardiovascular event rate in this group of patients. Electron beam-computed tomography (EBCT) is a noninvasive tec hnology for evaluating the extent of coronary artery atherosclerosis that r elies on the detection of coronary artery calcium (CAC). We used EBCT to de tect significant coronary artery atherosclerosis in diabetic patients witho ut symptoms of heart disease. RESEARCH DESIGN AND METHODS- We used EBCT to evaluate calcium in the corona ry arteries of 139 consecutive diabetic patients scanned over a 20-month pe riod. The CAC scores in this group were compared with a randomly selected n ondiabetic control group and a control group that was selected to match a n umber of established cardiovascular risk factors. RESULTS- Patients with diabetes had a significant increase in the prevalenc e of CAC scores greater than or equal to 400 (25.9%) compared with the rand omly selected (7.2%) and matched (14.4%) nondiabetic control groups. Scores in this range have been reported to be highly predictive for abnormal stre ss myocardial perfusion tomography and subsequent coronary events. CONCLUSIONS- Our results, therefore, indicate a substantial prevalence of s ignificant coronary artery disease in an asymptomatic diabetic patient popu lation compared with nondiabetic control subjects. They also suggest that E BCT may be a useful approach for selecting a group of diabetic subjects who would benefit most from additional evaluation for subclinical coronary art ery disease.