This investigation of the PREDICT study group sought to determine whether coronary calcium measurement would improve the prediction of cardiovascular events in patients with type 2 diabetes. A total of 589 asymptomatic patients with type 2 diabetes were followed for a median of four years during which 66 first cardiovascular events were reported. Electron beam computed tomography was used to estimate coronary calcium and a coronary artery calcium score (CACS) was developed. It was found that cardiovascular disease (CVD) risk was incrementally associated with the CACS and the highest risk was observed in patients with the highest CACS score (20-fold increased CVD risk compared to patients with the lowest score). In this cohort, the area under the receiver operating characteristic (ROC) curve for the United Kingdom Prospective Diabetes Study (UKPDS) was 0.63. After considering the CACS, the AUC under the ROC curve was increased to 0.73. Similarly, the area under the ROC curve for the Framingham risk engine was also 0.63, and addition of the CACS increased the area under the ROC curve to 0.74. As the findings of this study suggest that coronary artery calcium contributes significantly in the estimation of CVD events in patients with type 2 diabetes, study authors concluded that the clinical use of this method to estimate coronary calcium will likely depend on its cost-effectiveness. The PREDICT study group paper was accompanied by an editorial by Dr. Matthew J. Budoff who suggested that although 80% of individuals with type 2 diabetes will eventually suffer from CVD, in terms of cardiovascular risk, “not all diabetics are created equal.” In his opinion, although measuring CAC is useful to better identify patients at high CVD risk, caution is required regarding the widespread application of CT-measure coronary artery calcium, as the measurement is somewhat costly. Budoff suggested that cost-effectiveness has to be established before the measurement of coronary artery calcium is used in clinical settings for a better stratification of patients’ risk and a better dosage of the required lipid-lowering therapy.
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