Since 1990, a wealth of studies have evaluated the prognostic utility of coronary artery calcium (CAC) scoring for cardiovascular disease (CVD) risk assessment in the general population, as well as in specific patient subgroups, such as those at intermediate risk (5-20% 10-year CVD risk). More recently, attention has been placed on the potential utility of CAC informing therapy allocation in patients with diabetes mellitus (ie, to guide statin, aspirin, and novel antidiabetic drug use). Until now, however, most studies have included a majority (or even exclusively) of patients with type 2 diabetes. Type 1 diabetes mellitus (T1DM) has always been underrepresented.
To fill this evidence gap, Budoff and colleagues evaluated 1205 T1DM patients from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. The authors observed that CAC was also able to accurately stratify risk in this population. Patients with CAC >100 had significantly higher event rates than those with CAC=0 in multivariable-adjusted analyses. Noteworthy was the very low event rates observed in CAC=0 patients despite a very low baseline use of statins (mean age, 41.4 years).
Although this study represents a very valuable first step in understanding the potential utility of CAC scoring in diabetes—specifically in the T1DM subgroup—controlled studies are needed to better understand whether CAC can help differentiate patients most likely to get a net benefit from different cardiovascular therapies, and in those in whom the most aggressive therapies could be safely postponed. Specifically for statins, whether a CAC-guided individualized treatment approach improves the “treat almost all” strategy endorsed by both ADA and ACC/AHA 2019 guidelines also needs further evaluation.
To fill this evidence gap, Budoff and colleagues evaluated 1205 T1DM patients from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) study. The authors observed that CAC was also able to accurately stratify risk in this population. Patients with CAC >100 had significantly higher event rates than those with CAC=0 in multivariable-adjusted analyses. Noteworthy was the very low event rates observed in CAC=0 patients despite a very low baseline use of statins (mean age, 41.4 years).
Although this study represents a very valuable first step in understanding the potential utility of CAC scoring in diabetes—specifically in the T1DM subgroup—controlled studies are needed to better understand whether CAC can help differentiate patients most likely to get a net benefit from different cardiovascular therapies, and in those in whom the most aggressive therapies could be safely postponed. Specifically for statins, whether a CAC-guided individualized treatment approach improves the “treat almost all” strategy endorsed by both ADA and ACC/AHA 2019 guidelines also needs further evaluation.
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