Cardiometabolic risk is associated with atherosclerotic burden and prognosis: Results from the partners coronary computed tomography angiography registry

Edward Hulten, Sommer Bittencourt, Daniel O'Leary, Ravi Shah, Brian Ghoshhajra, Mitalee P. Christman, Philip Montana, Michael Steigner, Quynh A. Truong, Khurram Nasir, Frank Rybicki, Jon Hainer, Thomas J. Brady, Marcelo F. Di Carli, Udo Hoffmann, Suhny Abbara, Ron Blankstein

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

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 diabetesmellitus (T2DM) with fewer than three orwith three or more CMrisk factors, patients with T2DMnot requiring insulin, or those with T2DMrequiring 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.

Original languageEnglish (US)
Pages (from-to)555-564
Number of pages10
JournalDiabetes Care
Volume37
Issue number2
DOIs
StatePublished - Feb 2014

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Registries
Insulin
Coronary Artery Disease
Computed Tomography Angiography
Hypertriglyceridemia
Unstable Angina
Obesity
Myocardial Infarction
Hypertension
Mortality

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Hulten, E., Bittencourt, S., O'Leary, D., Shah, R., Ghoshhajra, B., Christman, M. P., ... Blankstein, R. (2014). Cardiometabolic risk is associated with atherosclerotic burden and prognosis: Results from the partners coronary computed tomography angiography registry. Diabetes Care, 37(2), 555-564. https://doi.org/10.2337/dc13-1431

Cardiometabolic risk is associated with atherosclerotic burden and prognosis : Results from the partners coronary computed tomography angiography registry. / Hulten, Edward; Bittencourt, Sommer; O'Leary, Daniel; Shah, Ravi; Ghoshhajra, Brian; Christman, Mitalee P.; Montana, Philip; Steigner, Michael; Truong, Quynh A.; Nasir, Khurram; Rybicki, Frank; Hainer, Jon; Brady, Thomas J.; Di Carli, Marcelo F.; Hoffmann, Udo; Abbara, Suhny; Blankstein, Ron.

In: Diabetes Care, Vol. 37, No. 2, 02.2014, p. 555-564.

Research output: Contribution to journalArticle

Hulten, E, Bittencourt, S, O'Leary, D, Shah, R, Ghoshhajra, B, Christman, MP, Montana, P, Steigner, M, Truong, QA, Nasir, K, Rybicki, F, Hainer, J, Brady, TJ, Di Carli, MF, Hoffmann, U, Abbara, S & Blankstein, R 2014, 'Cardiometabolic risk is associated with atherosclerotic burden and prognosis: Results from the partners coronary computed tomography angiography registry', Diabetes Care, vol. 37, no. 2, pp. 555-564. https://doi.org/10.2337/dc13-1431
Hulten, Edward ; Bittencourt, Sommer ; O'Leary, Daniel ; Shah, Ravi ; Ghoshhajra, Brian ; Christman, Mitalee P. ; Montana, Philip ; Steigner, Michael ; Truong, Quynh A. ; Nasir, Khurram ; Rybicki, Frank ; Hainer, Jon ; Brady, Thomas J. ; Di Carli, Marcelo F. ; Hoffmann, Udo ; Abbara, Suhny ; Blankstein, Ron. / Cardiometabolic risk is associated with atherosclerotic burden and prognosis : Results from the partners coronary computed tomography angiography registry. In: Diabetes Care. 2014 ; Vol. 37, No. 2. pp. 555-564.
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abstract = "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 diabetesmellitus (T2DM) with fewer than three orwith three or more CMrisk factors, patients with T2DMnot requiring insulin, or those with T2DMrequiring 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.",
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T1 - Cardiometabolic risk is associated with atherosclerotic burden and prognosis

T2 - Results from the partners coronary computed tomography angiography registry

AU - Hulten, Edward

AU - Bittencourt, Sommer

AU - O'Leary, Daniel

AU - Shah, Ravi

AU - Ghoshhajra, Brian

AU - Christman, Mitalee P.

AU - Montana, Philip

AU - Steigner, Michael

AU - Truong, Quynh A.

AU - Nasir, Khurram

AU - Rybicki, Frank

AU - Hainer, Jon

AU - Brady, Thomas J.

AU - Di Carli, Marcelo F.

AU - Hoffmann, Udo

AU - Abbara, Suhny

AU - Blankstein, Ron

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N2 - 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 diabetesmellitus (T2DM) with fewer than three orwith three or more CMrisk factors, patients with T2DMnot requiring insulin, or those with T2DMrequiring 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.

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 diabetesmellitus (T2DM) with fewer than three orwith three or more CMrisk factors, patients with T2DMnot requiring insulin, or those with T2DMrequiring 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.

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