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Diabetes 56:849-855, 2007
DOI: 10.2337/db06-0935
© 2007 by the American Diabetes Association
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Relationship of Traditional and Nontraditional Cardiovascular Risk Factors to Coronary Artery Calcium in Type 2 Diabetes

Theodore Mazzone1, Peter M. Meyer2, George T. Kondos3, Michael H. Davidson4, Steven B. Feinstein4, Ralph B. D’Agostino, Sr.5, Alfonso Perez6, and Steven M. Haffner7

1 Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Illinois College of Medicine, Chicago, Illinois
2 Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois
3 Department of Medicine, Section of Cardiology, University of Illinois College of Medicine, Chicago, Illinois
4 Department of Medicine, Section of Cardiology, Rush University Medical Center, Chicago, Illinois
5 Department of Mathematics, Statistics and Consulting Unit, Boston University, Boston, Massachusetts
6 Takeda Global Research and Development, Lincolnshire, Illinois
7 Department of Medicine, University of Texas Health Science Center, San Antonio, Texas

Address correspondence and reprint requests to Theodore Mazzone, MD, Section of Diabetes and Metabolism (MC 797), University of Illinois at Chicago, 1819 W. Polk St., Chicago, IL 60612. E-mail: tmazzone{at}uic.edu

Abbreviations: apo, apolipoprotein; CAC, coronary artery calcium; CACS, coronary artery calcium score; sBP, systolic blood pressure; TAT, total abdominal adipose tissue; TRL, triglyceride-rich lipoprotein; VAT, visceral adipose tissue; WHR, waist-to-hip ratio

We evaluated correlates of coronary atherosclerosis, measured by coronary artery calcium, in a racially diverse group of male and female subjects with type 2 diabetes. Age, systolic blood pressure, sex, and race/ethnicity were significant determinants of coronary artery calcium. Among lipoproteins, cholesterol level contained in a particle excluded from direct measures of LDL and HDL cholesterol (designated triglyceride-rich lipoprotein cholesterol) was most strongly linked to coronary artery calcium. Neither inflammatory markers nor metabolic factors correlated with coronary artery calcium in models adjusted for age and sex, but measures of adipose distribution did. Waist-to-hip ratio and the ratio of visceral to total abdominal tissue were positively associated with coronary artery calcium. In fully adjusted multivariate models, the relationship of adiposity measures to coronary artery calcium was no longer significant after inclusion of apolipoprotein B or triglyceride-rich lipoprotein cholesterol. Traditional risk factors and race/ethnicity remain important correlates of coronary artery calcium in a cohort at elevated risk of cardiovascular disease because of type 2 diabetes. Adiposity measures are significantly associated with coronary artery calcium score, but their importance may be largely explained by apolipoprotein B or triglyceride-rich lipoprotein cholesterol.


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Copyright © 2007 by the American Diabetes Association.