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Cardiovascular Risk Heterogeneity in Adults with Diabetes: Selective Use of Coronary Artery Calcium in Statin Use Decision-making

  • Sudipa SarkarEmail author
  • Olusola A. Orimoloye
  • Caitlin M. Nass
  • Roger S. Blumenthal
  • Seth S. Martin
Perspective

Abstract

Current American College of Cardiology/American Heart Association and American Diabetes Association guidelines recommend statin therapy for all patients with diabetes between the ages of 40 and 75, including those without cardiovascular disease (CVD). While diabetes is a major CVD risk factor, not all patients with diabetes have an equal risk of CVD. Thus, a more risk-based approach warrants consideration when recommending statin therapy for the primary prevention of CVD. Coronary artery calcium (CAC) is a noninvasive imaging modality that can help risk stratify patients with diabetes for future CVD events. CAC has been extensively studied in large cohorts such as the Multi-Ethnic Study of Atherosclerosis and found to outperform other novel risk stratification tools including carotid intima-media thickness. Moreover, a CAC score of 0 has been shown to be useful in downgrading the estimated risk of a CVD event in patients with diabetes and an intermediate Pooled Cohort Equation score. As clinicians weigh the recommendation for a lifelong therapy and the problem of statin nonadherence and patients weigh concerns about adverse effects of statins, the decision to initiate statin therapy in patients with diabetes is ideally a shared one between patients and providers, and CAC could facilitate this discussion.

KEY WORDS

coronary artery calcium diabetes cardiovascular disease 

Notes

Compliance with Ethical Standards

Conflict of Interest

SSM has no disclosures specifically related to coronary artery calcium imaging. He has received personal fees for serving on scientific advisory boards for Amgen, Sanofi/Regeneron, Quest Diagnostics, Esperion, Akcea Therapeutics, and Novo Nordisk. He reports grants/research support from the NIH, PJ Schafer Cardiovascular Research Fund, the David and June Trone Family Foundation, American Heart Association, Aetna Foundation, Maryland Innovation Initiative, Nokia, Google, and Apple; in addition, he is listed as a co-inventor on a patent application pending on a method of LDL-C estimation. All remaining authors declare that they do not have a conflict of interest.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Sudipa Sarkar
    • 1
    • 2
    Email author
  • Olusola A. Orimoloye
    • 2
  • Caitlin M. Nass
    • 1
  • Roger S. Blumenthal
    • 2
  • Seth S. Martin
    • 2
  1. 1.Division of Endocrinology, Diabetes, and Metabolism, Asthma and Allergy Center Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreUSA

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