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Value of Coronary Computed Tomography Angiography in Tailoring Aspirin Therapy for Primary Prevention of Atherosclerotic Events in Patients at High Risk With Diabetes Mellitus.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2016 Mar 15; Vol. 117 (6), pp. 887-93. Date of Electronic Publication: 2015 Dec 30. - Publication Year :
- 2016
-
Abstract
- Aspirin use for primary prevention in patients at high risk with diabetes mellitus (DM) is often recommended under the assumption that most patients with DM have coronary artery disease (CAD). However, not all patients may have CAD. The present study evaluated, in 425 patients at high risk with DM (without chest pain syndrome or a history of cardiac disease), the prevalence of CAD on coronary computed tomography angiography (CTA). Moreover, the association between the presence and number of traditional cardiovascular (CV) risk factors and CAD (on coronary CTA) was evaluated. The median coronary artery calcium score was 29 (interquartile range 0 to 298). On coronary CTA, 116 patients (27%) had no CAD (defined as <30% stenosis). Of the 309 patients (73%) with any CAD (≥30% stenosis), 35% had obstructive CAD (≥50% stenosis). The number of traditional CV risk factors was not associated with the presence of any CAD (≥30% stenosis; p = 0.18) or obstructive CAD (≥50% stenosis; p = 0.13). Hypertension was the only traditional CV risk factor associated with a higher frequency of any CAD (≥30% stenosis; odds ratio = 2.21, 95% CI 1.43 to 3.41, p <0.001) and obstructive CAD (≥50% stenosis; odds ratio 2.03, 95% CI 1.33 to 3.11, p = 0.001). In conclusion, in patients at high risk with DM without chest pain syndrome, any CAD was ruled out by coronary CTA in 27%, whereas 65% of the patients did not have obstructive CAD. The number of CV risk factors was not associated with the presence of CAD. Hypertension was the only traditional CV risk factor that was associated with a higher frequency of CAD. These observations support potential use of coronary CTA to tailor aspirin therapy in patients at high risk with DM.<br /> (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Body Mass Index
Coronary Artery Disease epidemiology
Coronary Artery Disease etiology
Diabetes Mellitus, Type 1 complications
Diabetes Mellitus, Type 2 complications
Female
Humans
Hypertension complications
Male
Middle Aged
Netherlands epidemiology
Predictive Value of Tests
Prevalence
Prospective Studies
Risk Assessment
Risk Factors
Sensitivity and Specificity
Treatment Outcome
Anti-Inflammatory Agents, Non-Steroidal administration & dosage
Aspirin administration & dosage
Coronary Angiography methods
Coronary Artery Disease diagnostic imaging
Coronary Artery Disease prevention & control
Primary Prevention
Tomography, X-Ray Computed
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 117
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 26803383
- Full Text :
- https://doi.org/10.1016/j.amjcard.2015.12.023