A Coronary Artery Calcium Score (CACS) Higher Than 100 Agatston Units is Associated with a Profile of Very High Cardiovascular Risk in the Diabetic Population

Rationale: CACS can improve the cardio-vascular risk (CVR) estimate and select the patients eligible for further cardio-vascular investigations. We aimed to examine the relationship between a CACS ≥100 Agatston units (AU) and integrators of CVR in the diabetic population. Patients and Methods: CACS was measured in type 2 diabetic patients without symptoms, history of coronary disease or ECG ischemic changes presenting ≥2 additional CVR factors. We included 338 patients with very high CVR (age 61±9 years, diabetes duration 15 ± 8 years, insulin treated 47%, hypertension 86%, dyslipidemia 88%, smokers 22%, lower limb artery disease 9.5% and/or carotid atheroma 5.5%, chronic kidney disease 48%). Silent myocardial ischemia (SMI) was assessed using stress myocardial scintigraphy. Artery stiffness indexes (pulse wave velocity (PWV) and augmentation index (AIx@75)) and Buckberg index of myocardial perfusion (SEVR) were measured with applanation tonometry (Sphygmocor®). Results: Compared with the patients with CACS <100 AU, the 139 patients (41%) with CACS ≥100 were less treated by metformin (73 vs. 88%, p<0.001) or GLP-1-receptor agonists (18 vs. 28%, p<0.05), but more treated by anti-hypertensive drugs, statins (79 vs. 70%, p=0.058) or fibrates (8.5 vs. 3.7%, p=0.072), with lower LDL-cholesterol levels (2.1±0.9 vs. 2.4±0.9 mmol/l, p<0.01). SMI prevalence (21.6 vs. 11.5%, OR 2.1[1.2-3.8], p<0.05), NT-proBNP (201±375 vs. 73±136 mg/L, p<0.01) and PWV (11.0±2.7 vs. 9.4±3.6 m/sec, p<0.01) were higher. However, the rate of elevated PWV (compared to normative data considering age and blood pressure), central pulse pressure and SEVR were very close in the two groups while AIx@75 was lower in the patients with CACS≥100 (22.1±9.3 vs. 26.4±10.0, p<0.01). Conclusion: The CACS ≥100 is a marker of very high CVR associated with a higher SMI prevalence and NT-proBNP levels. Artery stiffness and SEVR were not altered. Disclosure P. Valensi: None. I. Banu: None. M. Fysekidis: None. E. Cosson: Consultant; Self; Lilly France. Board Member; Self; Novartis France. Consultant; Self; Roche Diagnostics France. Board Member; Self; Ascensia Diabetes Care. Consultant; Self; Bezins France. Board Member; Self; MSD France.