Prospective evaluation of diabetic ischaemic heart disease by computed tomography: the PREDICT study

Abstract

Coronary heart disease (CHD) is the main cause of morbidity and mortality in type 2 diabetic subjects. Electron beam computed tomography (EBCT) of the coronary arteries provides a non-invasive method of detecting and quantifying coronary calcification (coronary calcium score), which is known to be an early marker of coronary atheroma in non-diabetic subjects. 600 type 2 diabetic subjects aged between 50 and 70 years of either sex will undergo EBCT. They will be followed-up for a mean period of four years. Recruitment started in September 2000 and preliminary results are expected in 2004. The primary aim is to assess the predictive power of the coronary calcium score for coronary events specifically in type 2 diabetic subjects. Secondary aims are to assess the relationship between coronary calcium score in type 2 diabetes and conventional risk factors, with novel risk markers, plasma homocysteine and C-reactive protein, and with key genetic markers of CHD.

Keywords

type 2 diabetes electron beam computed tomography coronary heart disease.

Get full access to this article

View all access options for this article.

References

Pyorala K. , Laakso M. Macrovascular disease in diabetes. In: Mann J , Pyorala K , Teuscher A , (eds.). Diabetes in Epidemiological Perspective . Churchill Livingstone, 1983:183-247.

Koskinen P. , Manttari M. , Manninen V. Coronary heart disease incidence in NIDDM patients in the Helsinki Heart Study . Diabetes Care 1992;13: 820-5.

Pyorala K. , Pedersen TR , Kjekshus J. , Faegeman O. , Olsson AG , Thorgeirsson G. The Scandinavian Simvastatin Survival Study (4S) Group. Cholesterol lowering with Simvastatin improves prognosis of diabetic patients with coronary heart disease. A subgroup analysis of the Scandinavian Simvastatin Survival study (4S). Diabetes Care 1997;20: 614-20.

Elkeles RS , Diamond JR , Poulter C. et al. and the SENDCAP Study Group. Cardiovascular outcomes in Type 2 diabetes. A double-blind placebo controlled study of bezafibrate: the St. Mary's, Ealing, Northwick Park Diabetes Cardiovascular Disease Prevention (SENDCAP) Study. Diabetes Care 1998;21:641-8.

Diabetes Atherosclerosis Intervention Study Investigators. Effect of fenofibrate on progression of coronary-artery disease in type 2 diabetes: the Diabetes Atherosclerosis Intervention Study, a randomised study. Lancet 2001;357:905-10.

Breen JF , Sheedy PF , Schwartz RS et al. Coronary artery calcification detected with ultrafast CT as an indication of coronary artery disease. Radiology 1992;185:435-49.

Arad Y. , Spadaro LA , Goodman K. et al. Predictive value of electron beam computed-tomography of the coronary arteries. 19-month follow up of 1173 asymptomatic subjects. Circulation 1996;93:1951-3.

Raggi P. , Callister TQ , Cooil B. et al. Identification of patients at increased risk of first unheralded myocardial infraction by electron beam computed tomography. Circulation 2000;101:850-5.

Keelan PC , Bielak LF , Ashai K. et al. Long term prognostic value of coronary calcification detected by electron beam computed tomography in patients undergoing coronary angiography . Circulation 2001;104:412-7.

10.

Thompson GR , Elkeles RS , Gibson K. , Rubens M. , Underwood R. Coronary calcification score and predicted risk of coronary heart disease. Atherosclerosis 2000;151:1-4.

11.

Turner RC , Millns H. , Neil HAW et al. for the United Kingdom Prospective Diabetes Study Group. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS 24). BMJ 1998;316:823-8.

12.

UK Prospective Diabetes Study Group. Ethnicity and Cardiovascular Disease: The incidence of myocardial infarction in white, South Asian, and Afro-Caribbean patients with Type 2 diabetes. (UK Prospective Diabetes Study 32). Diabetes Care 1998;21:1271-7.

13.

UK Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with Type 2 diabetes (UKPDS 32). Lancet 1998;352:837-53.

14.

Feher MD , Elkeles RS Lipid modification and coronary heart disease in Type 2 diabetes: different from the general population. Heart 1999;81: 10-11.

15.

Syvanne N. , Taskinen M-R. Lipids and lipoproteins as coronary risk factors in non-insulin dependent diabetes mellitus. Lancet 1997;350(suppl 1): 20-3.

16.

Laakso M. , Lehto S. , Penttila I. , Pyorala K. Lipids and lipoproteins predicting coronary heart disease mortality and morbidity in patients with non-insulin dependent diabetes. Circulation 1993;88[part1]:1421-30.

17.

Haffner SM , Miettinen H. Insulin resistance implications for type 2 diabetes mellitus and coronary heart disease. Am J Med 1997;103:152-62.

18.

Mogensen CE Microalbuminuria predicts mortality in non-insulin dependent diabetes. N Engl J Med 1984;310:356-60.

19.

Fuller JH , Stevens LK and the Diabetes Hypertension Study Group. Prevalence of hypertension among diabetic patients and its relation to vascular risk. J Hum Hypertension 1991;5:237-43.

20.

UK Prospective Diabetes Group. Tight blood pressure control and risk of macrovascular and microvascular complications in Type 2 diabetes: UKPDS 38. BMJ 1998;317:703-13.

21.

McCully KS , Ragsdale BD Production of arteriosclerosis by homocystinaemia. Am J Pathol 1970;61:1-11.

22.

Hoogeveen EK , Kostense PJ , Beks PJ et al. Hyperhomocysteinaemia is associated with an increased risk of cardiovascular disease, especially in non-insulin dependent diabetes mellitus: A population study. Arterioscler Thromb Vasc Biol 1998;18:133-8.

23.

Danesh J. , Whincup P. , Walker M. et al. Low grade inflammation and coronary heart disease: prospective study and updated meta-analyses. BMJ 2000;321:199-204.

24.

Ridker P. , Rifai N. , Cleafield M. et al. A: for the Airforce/Texas Coronary Atherosclerosis Prevention Study Programme. Measurement of C-reactive protein for the targeting of statin therapy in the primary prevention of coronary events. N Engl J Med 2001;344:1959-65.

25.

Meade TW , Brozovic M. , Chakrabarti R. et al. Haemostatic function and ischaemic heart disease: principal results of the Northwick Park Heart Study. Lancet 1982;2:533-7.

26.

Ganda OP , Arkin CF Hyperfibrinogenaemia: An important risk for vascular complications in diabetes . Diabetes Care 1992;15:1245-50.

27.

Wilson PW , Schaefer EJ , Larson MG , Ordova JM Apolipoprotein E alleles and risk of coronary heart disease: A meta-analysis . Arterioscl Thromb Vasc Bio 1996;16:150-5.

28.

Humphries SE , Luong LA , Ogg MS , Hawe E. , Miller GJ The interleukin-6-174 G/C promoter polymorphism is associated with risk of cardiovascular events and with systolic blood pressure in healthy men. Eur Heart J (in press).

29.

Woessner JF Matrix metalloproteinases and their inhibitors in connective tissue remodelling. FASEB J 1991;5:2145-54.

30.

Mackness B. , Durrington PN , Mackness MI Human serum paraoxonase . Gen Pharmacol 1998;31:329-36.

31.

Garin MC , James RW , Dussoix P. et al. Paraoxonase polymorphism Met-Leu54 is associated with modified serum concentrations of the enzyme. A possible link between the paraoxonase gene and increased risk of cardiovascular disease in diabetes. J Clin Invest 1997;99:62-6.

32.

Foger B. , Ritsch A. , Doblinger A. , Wessels H. , Patsch JR Relationship of plasma cholesteryl ester transfer protein to HDL cholesterol. Studies in normotriglyceridemia and moderate hypertriglyceridemia. Arterioscler Thromb Vasc Biol 1996;16:1430-6.

33.

Talmud PJ , Edwards KL , Turner CM et al. Linkage of the cholesteryl ester transfer protein (CETP) gene to LDL particle size. Circulation 2000;101:2461-6.

34.

Austin MA , Breslow JL , Hennekens CH , Willet WC , Krauss RM Low density subclass patterns and risk of myocardial infarction. JAMA 1996;260: 1917-21.

35.

Valabhji J. , McColl AJ , Richmond WR , Schacter M. , Rubens MB , Elkeles RS Total antioxidant status and coronary artery calcification in Type 1 diabetes . Diabetes Care 2001;24:1608-13.

36.

Janowitz WR , Agatston AS , Kaplan G. , Viamonte M. Differences in prevalence and extent of coronary artery calcium detected by ultrafast computed tomography in asymptomatic men and women. Am J Cardiol 1993;72:247-54.

37.

Agatston A. , Janowitz W. , Hildner F. , Zusmer N. , Viamonte Mj , Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography . J Am Coll Cardiol 1990;15:827-32.

38.

Rumberger JA , Brundage BH , Rader D. , Kondos G. Electron beam computed tomographic coronary calcium scanning: A review and guidelines for use in asymptomatic persons . Mayo Clin Proc 1999;74: 243-52.

39.

Matthews DR , Hosker JP , Rudenski AS , Naylor BA , Treacher DF , Turner RC Homeostasis model assessment: insulin resistance and -cell function from fasting plasma glucose and insulin concentration in man. Diabetologia 1985;28:412-9.

40.

Miller SA , Dykes DD , Polesky HF A simple salting out procedure for extracting DNA from human nucleated cells . Nucleic Acids Res 1988;16: 1215.

41.

Day IN , Humphries SE Electrophoresis for genotyping: microtiter array diagonal gel electrophoresis on horizontal polyacrylamide gels, hydrolink, or agarose. Ann Biochem 1994;222:389-95.

42.

Tuomilehto J. , Ratenyte D. , Birkenhager WH et al. for the Systolic Hypertension in Europe Trial Investigators. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension . N Engl J Med 1999;340:677-84.

43.

Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 1998;80(suppl 2):S1-S29.