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
- 1Department of Medicine, Section of Endocrinology, Diabetes and Metabolism, University of Illinois College of Medicine, Chicago, Illinois
- 2Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois
- 3Department of Medicine, Section of Cardiology, University of Illinois College of Medicine, Chicago, Illinois
- 4Department of Medicine, Section of Cardiology, Rush University Medical Center, Chicago, Illinois
- 5Department of Mathematics, Statistics and Consulting Unit, Boston University, Boston, Massachusetts
- 6Takeda Global Research and Development, Lincolnshire, Illinois
- 7Department 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
Abstract
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.
- 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
Footnotes
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T.M. has acted as a consultant for Takeda, Merck, Amylin, and Novartis; has received grant support from Takeda; and has received honoraria from Merck, Pfizer, Takeda, and Novartis. P.M.M. has acted as a consultant for Takeda. G.T.K. has acted as a consultant to and has received research support from Takeda. M.H.D. has received grant/research support or honoraria from or has acted as a consultant/speaker for Abbott, Astra Zeneca, Bristol-Myers Squibb, Kos, Merck, Merck/Schering-Plough, Pfizer, Novartis, Reliant, Roche, Sankyo, Sumitomo, and Takeda. S.B.F. has acted as a consultant for Takeda. R.B.D. has acted as a consultant for Takeda, Pfizer, Bayer, and Sanofi. S.M.H. has acted as a consultant for GlaxoSmithKline, Pfizer, Astra Zeneca, and Merck Sharpe & Dohme and has received grant support from Pfizer and Novartis.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted December 11, 2006.
- Received July 6, 2006.
- DIABETES
