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Rates and determinants of coronary and abdominal aortic artery calcium progression in the Veterans Affairs Diabetes Trial (VADT).

Saremi A, Moritz TE, Anderson RJ, Abraira C, Duckworth WC, Reaven PD, Veterans Affairs Diabetes Trial (VAD - Diabetes Care (2010)

Bottom Line: To determine the predictors of progression of calcified atherosclerosis and the effect of intensive glycemic control on this process in patients with type 2 diabetes.In addition, annualized percent change of volume scores was determined.Intensive glycemic control during the VADT did not reduce progression of calcified atherosclerosis.

View Article: PubMed Central - PubMed

Affiliation: Phoenix VA Health Care System, Phoenix, Arizona, USA.

ABSTRACT

Objective: To determine the predictors of progression of calcified atherosclerosis and the effect of intensive glycemic control on this process in patients with type 2 diabetes.

Research design and methods: As part of the Risk Factors, Atherosclerosis, and Clinical Events in Diabetes (RACED) substudy of the Veterans Affairs Diabetes Trial (VADT), 197 and 189 individuals with type 2 diabetes received baseline and follow-up computed tomographic scans for measurement of coronary and abdominal artery calcium, respectively. Standard and novel risk factors were assessed at baseline, and progression of calcified atherosclerosis was determined by several methods. Progression was defined both as a categorical (square root increase of volumetric scores ≥ 2.5 mm(3)) and continuous variable. In addition, annualized percent change of volume scores was determined.

Results: After an average follow-up of 4.6 years, >75% of individuals demonstrated coronary (CAC) and abdominal artery calcification (AAC) progression. Progression increased with higher baseline calcium categories but was not influenced by standard risk factors. However, the albumin-to-creatinine ratio (ACR) (P = 0.02) and lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) (P = 0.01) predicted progression of CAC, and these results were not altered by adjustment for age and other traditional risk factors. Treatment assignment (intensive versus standard) within the VADT did not influence CAC or AAC progression, irrespective of baseline calcium category.

Conclusions: In patients with long-standing type 2 diabetes, baseline CAC, Lp-PLA(2), and ACR predicted progression of CAC. Intensive glycemic control during the VADT did not reduce progression of calcified atherosclerosis.

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Progression of CAC or AAC by treatment assignment. A: Median and 25th–75th percentiles of CAC progression by treatment group in all participants and by baseline CAC categories. The P value for the comparison between the treatment groups was not significant in all participants or in any baseline CAC categories. B: Median and 25th–75th percentiles of AAC progression by treatment group in all participants and by baseline AAC categories. The P value for the comparison between the treatment groups was not significant in all participants or in any baseline AAC categories. □, standard group; ■, intensive treatment group.
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Figure 1: Progression of CAC or AAC by treatment assignment. A: Median and 25th–75th percentiles of CAC progression by treatment group in all participants and by baseline CAC categories. The P value for the comparison between the treatment groups was not significant in all participants or in any baseline CAC categories. B: Median and 25th–75th percentiles of AAC progression by treatment group in all participants and by baseline AAC categories. The P value for the comparison between the treatment groups was not significant in all participants or in any baseline AAC categories. □, standard group; ■, intensive treatment group.

Mentions: Treatment assignment did not significantly influence either CAC or AAC progression, whether determined by cumulative incidence (supplemental Fig. 2A, available in an online appendix), annual percent change (supplemental Fig. 2B), or absolute progression (Fig. 1). Moreover, no effects of treatment assignment were seen for progression of either CAC or AAC at any level of baseline calcium (Fig. 1). Similarly, even though there was evidence for different rates of CAC progression between NHW and other ethnic/racial groups (supplementary Table 1) treatment assignment did not influence CAC or AAC progression in either of these groups.


Rates and determinants of coronary and abdominal aortic artery calcium progression in the Veterans Affairs Diabetes Trial (VADT).

Saremi A, Moritz TE, Anderson RJ, Abraira C, Duckworth WC, Reaven PD, Veterans Affairs Diabetes Trial (VAD - Diabetes Care (2010)

Progression of CAC or AAC by treatment assignment. A: Median and 25th–75th percentiles of CAC progression by treatment group in all participants and by baseline CAC categories. The P value for the comparison between the treatment groups was not significant in all participants or in any baseline CAC categories. B: Median and 25th–75th percentiles of AAC progression by treatment group in all participants and by baseline AAC categories. The P value for the comparison between the treatment groups was not significant in all participants or in any baseline AAC categories. □, standard group; ■, intensive treatment group.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992205&req=5

Figure 1: Progression of CAC or AAC by treatment assignment. A: Median and 25th–75th percentiles of CAC progression by treatment group in all participants and by baseline CAC categories. The P value for the comparison between the treatment groups was not significant in all participants or in any baseline CAC categories. B: Median and 25th–75th percentiles of AAC progression by treatment group in all participants and by baseline AAC categories. The P value for the comparison between the treatment groups was not significant in all participants or in any baseline AAC categories. □, standard group; ■, intensive treatment group.
Mentions: Treatment assignment did not significantly influence either CAC or AAC progression, whether determined by cumulative incidence (supplemental Fig. 2A, available in an online appendix), annual percent change (supplemental Fig. 2B), or absolute progression (Fig. 1). Moreover, no effects of treatment assignment were seen for progression of either CAC or AAC at any level of baseline calcium (Fig. 1). Similarly, even though there was evidence for different rates of CAC progression between NHW and other ethnic/racial groups (supplementary Table 1) treatment assignment did not influence CAC or AAC progression in either of these groups.

Bottom Line: To determine the predictors of progression of calcified atherosclerosis and the effect of intensive glycemic control on this process in patients with type 2 diabetes.In addition, annualized percent change of volume scores was determined.Intensive glycemic control during the VADT did not reduce progression of calcified atherosclerosis.

View Article: PubMed Central - PubMed

Affiliation: Phoenix VA Health Care System, Phoenix, Arizona, USA.

ABSTRACT

Objective: To determine the predictors of progression of calcified atherosclerosis and the effect of intensive glycemic control on this process in patients with type 2 diabetes.

Research design and methods: As part of the Risk Factors, Atherosclerosis, and Clinical Events in Diabetes (RACED) substudy of the Veterans Affairs Diabetes Trial (VADT), 197 and 189 individuals with type 2 diabetes received baseline and follow-up computed tomographic scans for measurement of coronary and abdominal artery calcium, respectively. Standard and novel risk factors were assessed at baseline, and progression of calcified atherosclerosis was determined by several methods. Progression was defined both as a categorical (square root increase of volumetric scores ≥ 2.5 mm(3)) and continuous variable. In addition, annualized percent change of volume scores was determined.

Results: After an average follow-up of 4.6 years, >75% of individuals demonstrated coronary (CAC) and abdominal artery calcification (AAC) progression. Progression increased with higher baseline calcium categories but was not influenced by standard risk factors. However, the albumin-to-creatinine ratio (ACR) (P = 0.02) and lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) (P = 0.01) predicted progression of CAC, and these results were not altered by adjustment for age and other traditional risk factors. Treatment assignment (intensive versus standard) within the VADT did not influence CAC or AAC progression, irrespective of baseline calcium category.

Conclusions: In patients with long-standing type 2 diabetes, baseline CAC, Lp-PLA(2), and ACR predicted progression of CAC. Intensive glycemic control during the VADT did not reduce progression of calcified atherosclerosis.

Show MeSH
Related in: MedlinePlus