Category: Lipids/CV Health

Monitor: 1

1 - Comparing Coronary Artery Calcium and Atherosclerotic Cardiovascular Disease Risk Scores in Metabolic Syndrome Patients in a Community Based Population Without Known Cardiovascular Disease.

Thursday, Apr 25
12:00 PM – 12:30 PM

Objective :

American College of Cardiology gives Class IIB recommendation to coronary artery score (CAC) when risk-based treatment decisions are uncertain. We examined relationship between CAC and patients with and without metabolic syndrome as defined by International Diabetes Foundation (MS IDF) and American Heart Association (MS AHA) in population without known cardiovascular disease (CVD).


Methods : Retrospective chart review of patients ages 18 to 99 years referred for CAC (April 2010 and May 2015) at our institution was performed.  Incomplete documentations for known CVD (n=0) were excluded. IDF and AHA definitions were diagnosed using ICD9 codes and lab results of triglycerides >150mg/dL, fasting glucose >100mg/dL, HDL 130/85 md/dL and either central obesity with BMI >30kg/m2 or waist circumference >40 inches in males, 35 in females. CAC cutoff of >75th % and Agatston risk scores of 0 (very low), 1-100 (moderate), 101-400 (moderately high), and >401 (high) were used. Atherosclerotic cardiovascular disease (ASCVD) risk scores were divided into: low (0-5%), intermediate (>5-7.5%), high (>7.5-10%), very high (>10%). CVD was assumed with LDL >190mg/dL  and DM. Data were analyzed using SPSS statistical software.


Results :

Of 674 patients 50.7% were females, 49.3% males, mean age 57.7 (range 24 to 88 years), Caucasian (92.3%) 5.1% African American, 1.8% Asian, 0.6% Hispanic, and 0.3% Other. CAC ranged from 0-5416.  21.1% (194) patients met AHA definition for MS and 26.4% (155) met IDF criteria.  40.1% of MS IDF and 44% MS AHA had CAC >75% vs. 23.7% of non MS IDF and 24% non MS AHA. (p<0.001).  30% MS AHA had CAC of 0, 27% 1-100, 21% 101-400 and 23% >401 (p<0.001). ASCVD risk was low in 21.4% IDF and 16% AHA, intermediate in 11.2% IDF and 12% AHA, high in 7.5% IDF and 7.4% AHA, very high in 24.1% IDF and 24% AHA. 35.9% IDF and 40% AHA met presumed CVD criteria. (p<0.001). 


 


Discussion :

In this community based population without CVD four in ten patients with metabolic syndrome had CAC >75% and one third were at high risk for ASCVD even with diabetes excluded. Additionally, one in ten had intermediate risk for CVD. 40% of the population was at risk for ACSVD and had very high calcium scores on noninvasive imaging. 


Conclusion :

With increasing prevalence of MS noninvasive screening for risk stratification should be considered in these patients given CVD complications. Early primary prevention and risk factor modification needs to be implemented in order to prevent complications. 

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Theresa Ratajczak

Fellow
Wright State University, Ohio

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Arpan Patel

Fellow
Wright State University

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Amy Jiang

Resident in Training
Wright State University

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Saagar Sanghvi

Resident
University of Cincinnati

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Mukul Chandra

Clinical Professor
Wright State University

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Theresa Ratajczak

Fellow
Wright State University, Ohio

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Ahmed El Moghraby