Coronary Artery Calcium Scanning in Asymptomatic Patients with Diabetes Mellitus: A Paradigm Shift.

Mount Sinai School of Medicine.
Journal of Diabetes (Impact Factor: 1.93). 06/2012; 4(4). DOI: 10.1111/j.1753-0407.2012.00212.x
Source: PubMed


Coronary artery calcium (CAC) is the most powerful cardiac risk prognosticator in the asymptomatic population, with consistent superiority to all risk factor based paradigms. More recently, the strong prognostic value of changes in CAC has been demonstrated. The application of CAC to asymptomatic patients with diabetes mellitus (DM), all of whom have been presumed to be of high risk, has yielded a range of risks from low to high, proportional to the amount of calcified plaque as in patients without DM. These risks are higher than in nondiabetic patients at corresponding CAC levels, except for those without CAC who have the same low risk as nondiabetic patients. In addition, the value of serial scanning to assess plaque progression and prognosis in persons with DM has been demonstrated. Therefore, we propose that : 1) DM is not a coronary artery disease equivalent; 2) CAC be routinely employed in all asymptomatic diabetic patients older than 40 years as proposed by ACC/AHA guidelines; 3) serial CAC scanning be considered for evaluation of the response to therapy.

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