Highlights
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Background
The pharmacological management of diabetes is mainly based on its cardiovascular risk assessment. To this end, the coronary artery calcium score (CACS) is proposed with a soft recommendation (class IIb), since its prognostic implication requires more evidence in different subgroups.
Therefore, we conducted a systematic review and meta-analysis to address the prevalence of elevated CACS, its determinants and prognostic value in asymptomatic diabetic patients, with special attention to different sexes and ethnic groups.
Methods
We conducted a systematic review of the literature published in various databases between 01/2000 and 01/2021. Original studies were included if they presented data on the prevalence, determinants, and prognosis of high CACS in patients with diabetes without known cardiovascular disease.
Using random effects models, we calculated the pooled odds ratios (OR) for the determinants of CACS and the relative risk (RR) for the prognostic value of CACS on all-cause mortality and/or fatal and non-fatal CV events in different categories.
Results
23 studies were included (n = 20,999 patients). Females and black ethnic groups had the lowest prevalence of CACS>0. Age, male sex, non-black ethnicity, and duration of diabetes were identified as risk factors for high CACS.
Among the 10 studies (n = 110,396 person-years) with prognostic data, the pooled RR for the occurrence of all-cause death and/or cardiovascular events was 4.03 (95% CI: 3.04–5 .34), 5.87 (95% CI: 4.32–7.99) and 9.04 (95% CI: 5.81–14.06) respectively for CACS>0 vs. CACS = 0, CACS ≥100 versus CACS<10 and CACS≥400 versus CACS<10.
For similar CACS, these RRs were higher in women than in men.
Conclusion
Our meta-analysis demonstrates that increased CACS is strongly associated with an increased risk of all-cause mortality and/or fatal and non-fatal CV events in asymptomatic patients with diabetes.
Comments
This systematic review and meta-analysis evaluated the prevalence of high coronary artery calcium score (CACS) and the prognostic value of high CACS in asymptomatic patients with diabetes.
Women and black people had the lowest prevalence of CACS >0, while male sex, non-black ethnicity, and duration of diabetes were identified as risk factors for high CACS.
Furthermore, high CACS was associated with an increased risk of all-cause mortality and/or fatal and non-fatal cardiovascular events in asymptomatic patients with diabetes.
These findings may be clinically relevant for this patient population; however, further studies investigating the exact utility and predictive value of the CACS test are warranted.
