PMID- 24130364
OWN - NLM
STAT- MEDLINE
DCOM- 20141128
LR  - 20190318
IS  - 1935-5548 (Electronic)
IS  - 0149-5992 (Linking)
VI  - 37
IP  - 2
DP  - 2014 Feb
TI  - Cardiometabolic risk is associated with atherosclerotic burden and prognosis: 
      results from the partners coronary computed tomography angiography registry.
PG  - 555-64
LID - 10.2337/dc13-1431 [doi]
AB  - OBJECTIVE: Our purpose was to evaluate coronary artery disease (CAD) prevalence 
      and prognosis according to cardiometabolic (CM) risk. RESEARCH DESIGN AND 
      METHODS: Registry of all patients without prior CAD referred for coronary 
      computed tomography angiography (CCTA). Patients were stratified by groups of 
      increasing CM risk factors (hypertension, low HDL, hypertriglyceridemia, obesity, 
      and dysglycemia) as follows: patients without type 2 diabetes mellitus (T2DM) 
      with fewer than three or with three or more CM risk factors, patients with T2DM 
      not requiring insulin, or those with T2DM requiring insulin. Patients were 
      followed for a primary end point of major adverse cardiovascular events (MACE) 
      composed of unstable angina, late coronary revascularization, myocardial 
      infarction (MI), and cardiovascular mortality. RESULTS: Among 1,118 patients 
      (mean age 57 +/- 13 years) followed for a mean 3.1 years, there were 21 (1.9%) 
      cardiovascular deaths and 13 (1.2%) MIs. There was a stepwise increase in the 
      prevalence of obstructive CAD with increasing CM risk, from 15% in those without 
      diabetes and fewer than three CM risk factors to as high as 46% in patients with 
      T2DM requiring insulin (P < 0.001). Insulin exposure was associated with the 
      highest adjusted hazard of MACE (hazard ratio 3.29 [95% CI 1.28-8.45], P = 0.01), 
      whereas both T2DM without insulin (1.35, P = 0.3) and three or more CM risk 
      factors without T2DM (1.48, P = 0.3) were associated with a similar rate of MACE. 
      CONCLUSIONS: Patients without diabetes who have multiple metabolic risk factors 
      have a similar prognosis and burden of CAD as those with T2DM not requiring 
      insulin. Among patients with diabetes, the need for insulin therapy is associated 
      with greater burden of CAD as well as worse prognosis.
FAU - Hulten, Edward
AU  - Hulten E
AD  - Corresponding author: Edward Hulten, ehulten@partners.org.
FAU - Bittencourt, Marcio Sommer
AU  - Bittencourt MS
FAU - O'Leary, Daniel
AU  - O'Leary D
FAU - Shah, Ravi
AU  - Shah R
FAU - Ghoshhajra, Brian
AU  - Ghoshhajra B
FAU - Christman, Mitalee P
AU  - Christman MP
FAU - Montana, Philip
AU  - Montana P
FAU - Steigner, Michael
AU  - Steigner M
FAU - Truong, Quynh A
AU  - Truong QA
FAU - Nasir, Khurram
AU  - Nasir K
FAU - Rybicki, Frank
AU  - Rybicki F
FAU - Hainer, Jon
AU  - Hainer J
FAU - Brady, Thomas J
AU  - Brady TJ
FAU - Di Carli, Marcelo F
AU  - Di Carli MF
FAU - Hoffmann, Udo
AU  - Hoffmann U
FAU - Abbara, Suhny
AU  - Abbara S
FAU - Blankstein, Ron
AU  - Blankstein R
LA  - eng
PT  - Journal Article
DEP - 20131015
PL  - United States
TA  - Diabetes Care
JT  - Diabetes care
JID - 7805975
SB  - IM
MH  - Aged
MH  - Atherosclerosis/diagnostic imaging/*epidemiology
MH  - Coronary Angiography/methods
MH  - Coronary Artery Disease/diagnostic imaging/*epidemiology
MH  - Diabetes Mellitus, Type 2/*epidemiology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prevalence
MH  - Prognosis
MH  - Registries
MH  - Risk Factors
MH  - Tomography, X-Ray Computed/methods
EDAT- 2013/10/17 06:00
MHDA- 2014/12/15 06:00
CRDT- 2013/10/17 06:00
PHST- 2013/10/17 06:00 [entrez]
PHST- 2013/10/17 06:00 [pubmed]
PHST- 2014/12/15 06:00 [medline]
AID - dc13-1431 [pii]
AID - 10.2337/dc13-1431 [doi]
PST - ppublish
SO  - Diabetes Care. 2014 Feb;37(2):555-64. doi: 10.2337/dc13-1431. Epub 2013 Oct 15.