Impact of the coronary artery calcium score on the cardiovascular preventive management of asymptomatic patients with diabetes

Abstract

Abstract Background Coronary artery calcium (CAC) scoring with non-contrast computed tomography is increasingly used for cardiovascular risk stratification and provides a measure of coronary atherosclerotic burden of particular interest for risk stratification in patients with diabetes. We aimed to assess the impact of CAC on the management of asymptomatic patients with diabetes. Methods We studied consecutive asymptomatic patients who underwent CAC for cardiovascular risk stratification for diabetes, from 01/2014 to 12/2020. The study population was subdivided according to the CAC score into 4 subgroups: CAC=0, CAC 1-99, CAC 100-399 and CAC ≥400. We focused on the prescription of aspirin, lipid-lowering therapy (LLT) and glucagon-like peptide-1 receptor agonists (GLP1-RA) before and within 6 months after CAC estimation. Results We studied 371 patients (mean age 59.9 ± 10.6 years, 49.3% males). The study population was subdivided according to CAC as follows: CAC = 0 (N=90, 24.3%); CAC 1-99 (N=111, 29.9%); CAC 100-399 (N=70, 18.9%); CAC ≥400 (N=100, 26.9%). Patients with higher CAC (100-399 and CAC ≥400) were older, more often males and had higher prevalence of hypertension and dyslipidaemia. At baseline, the prescription of aspirin and lipid-lowering drugs was statistically higher in presence of CAC>100 (all p<0.001) while no difference was found regarding GLP1-RA prescription among the 4 subgroups (Figure). After CAC estimation, we found no modification in prescription of aspirin in patients with CAC=0 and CAC 1-99. Conversely, aspirin prescription significantly increased from 27.1% to 41.4% and from 40 to 56% in CAC 100-399 and CAC≥400 (p=0.002 and p<0.001), respectively. Similarly, significant changes (initiation or intensification) of LLT were only observed in presence of CAC 100-399 and CAC≥400 ([8.6% and 7.1%; p=0.031] and [19% and 20%; p<0.001], respectively) (Figure). No significant change was found regarding GLP1-RA prescription before and after CAC estimation in the 4 subgroups. Conclusion CAC represents an interesting tool to stratify asymptomatic patients with diabetes but there is room for improvement in preventive management of those stratified at the highest risk levels. Important efforts should be made to introduce the use of GLP1-RAs among cardiologists.Figure