Name:
Monteleone: Calcium Artery Calcification in Diabetic Patients Podcast
Description:
Monteleone: Calcium Artery Calcification in Diabetic Patients Podcast
Thumbnail URL:
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Duration:
T00H05M31S
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https://cadmoreoriginalmedia.blob.core.windows.net/c3046873-3513-4ad4-b712-a9c4daf013f2/5746998400001.mp4?sv=2019-02-02&sr=c&sig=wCUPpK2Xzbw71fdZzOl3tLMUaQcPQLffZHzUwnc7vzk%3D&st=2024-05-01T18%3A01%3A46Z&se=2024-05-01T20%3A06%3A46Z&sp=r
Upload Date:
2022-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
♪ MUSIC: ♪
DR. BERNIE: If you have calcification, you have coronary artery disease. The issue is, what is the significance of it, and what is the value of doing calcium score on everybody, the appropriateness on some people? Where is the return on the cost, the radiation, as to whether or not you change the treatment to change outcomes?
♪ MUSIC: ♪ Welcome to Practice Impact Extra. Dr. Bernie here. There were several recent publications that sparked my interest to revisit the appropriateness of calcium artery scoring, but particularly in the diabetic patients. For background, in the 1950s, heart disease was recognized as a significant cause of mortality in the United States. Significant interest was again directed towards the relationship of coronary artery calcification and heart disease mortality.
♪ MUSIC: It is clear and has been shown by anatomists, pathologists, that coronary artery calcium was not a risk but really is the actual disease. With the development of other means to detect coronary artery disease-- cardiac catheterization, nuclear stress testing-- the identification of coronary artery calcification interest seemed to have ended. Again, interest increased. In the 1990s, research indicated that coronary artery calcification was an excellent way to classify individuals at increased risk for heart disease.
♪ MUSIC: So, let's fast-forward to now and talk about the appropriate use. In type 2 diabetes, in type 2 diabetic patients, can coronary artery calcification provide additional information about coronary vascular disease, and coronary vascular mortality, beyond the Framingham Risk Score factors? I think this is a really important question. Why? There are 29 million Americans who suffer from type 2 diabetes. The recent evidence suggests that diabetes is not necessarily a coronary artery disease equivalent.
♪ MUSIC: It is well known that diabetes-affected individuals experience a poorer prognosis compared to non-diabetic patients, secondary to increased cardiovascular mortality. So, I want to comment on two important studies that I analyzed and have been analyzing the literature, looking at traditional risk factors and coronary artery calcification in diabetic patients. The first study is the Diabetic Heart Study.
♪ MUSIC: This was a study of 1,100 individuals with type 2 diabetes. And they were separated using coronary artery calcification scoring, and they were followed by 7.4 years. The study examined the association of the calcium artery calcification score and cardiovascular disease mortality, adjusting for Framingham Risk Score. The results led researchers to conclude that coronary artery calcification predicted CVD mortality, independent of functional risk score factors.
♪ MUSIC: Indeed, individuals with a zero calcium score had a low risk of events over the next ten years, and noted, however, that the risk would increase as the coronary artery calcium scores increased. That's the Diabetic Heart Study. There was a more recent trial reported, the MESA trial. That was the Multi-Ethnic Study of Atherosclerosis. This analysis was a sub-group analysis of the original 6,700 individuals, and that identified in the trial 881 diabetic patients.
♪ MUSIC: Review of this analysis demonstrated that the addition of the calcium artery score to the functional risk Framingham scores significantly improved the risk classification as well as predicting CVD disease in advance. So again, another trial that said that calcium score improved, over the Framingham Risk Score, the classification of diabetic patients as it relates to cardiovascular disease.
♪ MUSIC: So, what's the take-home message here? Clearly, diabetic patients represent a significant challenge. Obviously, this challenge must be addressed, because we need to address the very poor outcomes in diabetic patients. I believe that each patient, particularly each diabetic patient, needs to have that personalized, individual risk evaluation, and a treatment plan using traditional metabolic blood assessment, FRS, MESA risk score, and appropriate imaging to assess classification.
♪ MUSIC: Using guidelines, and with appropriate classification of risk, you can make a difference. Thanks for listening, and I hope you join me next time on Practice Impact Extra.
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