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Coronary Calcium Density and Incident Coronary Heart Disease among those with Diabetes or the Metabolic Syndrome: The Multiethnic Study of Atherosclerosis (MESA)


Background: Coronary calcium density was recently found to be inversely associated with incident coronary heart disease (CHD) and cardiovascular disease (CVD) events. Not known is whether this relationship may differ in those with diabetes (DM) or the metabolic syndrome (MetS).

Methods: We included 3,826 participants aged 45-84 years from The Multiethnic Study of Atherosclerosis (MESA) with a non-zero Agatston score and classified them as DM (18%), MetS without DM (29%) or neither condition (53%). The relation of density scores and volume scores with incident CHD and CVD events were examined stratified by statin use.

Results: During a 9.7-year mean follow-up, 67 (10%), 79 (7%), 102 (5%) CHD events happened among those with DM, MetS, or neither condition. The inverse relation between density score and CHD incidence appeared stronger in non-statin users among those with DM (hazard ratio: 0.52, 95% CI: 0.24-1.11) and those with MetS (HR: 0.51, 95% CI: 0.34-0.78). The 4th quartile of density score in those with MetS had a 73% lower CHD risk (p<0.01) than those in the 1st quartile compared to 36% (p=0.37) and 24% (p=0.56) for those with DM or neither disease.

Conclusion: Density score is inversely related to CHD in MetS population and those with neither DM nor MetS. In MetS or DM population this inverse relationship appears strongest in those not on statins, suggesting statin use may attenuate the association between plaque density and incident CHD events.

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