Diabetes and male sex are key risk factor correlates of the extent of coronary artery calcification: A Euro-CCAD study

J Diabetes Complications. 2017 Jul;31(7):1096-1102. doi: 10.1016/j.jdiacomp.2017.03.013. Epub 2017 Mar 31.


Background and aims: Although much has been written about the conventional cardiovascular risk factor correlates of the extent of coronary artery calcification (CAC), few studies have been carried out on symptomatic patients. This paper assesses the potential ability of risk factors to associate with an increasing CAC score.

Methods: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and the USA. All had conventional cardiovascular risk factor assessment and CT scanning for CAC scoring.

Results: Among all patients, male sex (OR = 4.85, p<0.001) and diabetes (OR = 2.36, p<0.001) were the most important risk factors of CAC extent, with age, hypertension, dyslipidemia and smoking also showing a relationship. Among patients with CAC, age, diabetes, hypertension and dyslipidemia were associated with an increasing CAC score in males and females, with diabetes being the strongest dichotomous risk factor (p<0.001 for both). These results were echoed in quantile regression, where diabetes was consistently the most important correlate with CAC extent in every quantile in both males and females. To a lesser extent, hypertension and dyslipidemia were also associated in the high CAC quantiles and the low CAC quantiles respectively.

Conclusion: In addition to age and male sex in the total population, diabetes is the most important correlate of CAC extent in both sexes.

Keywords: Coronary calcification extent; Diabetes; Gender; Hypertension; Risk factors.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Cohort Studies
  • Computed Tomography Angiography
  • Coronary Artery Disease / complications*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology
  • Coronary Artery Disease / etiology
  • Cross-Sectional Studies
  • Diabetic Angiopathies / diagnostic imaging
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / etiology*
  • Diabetic Angiopathies / physiopathology
  • Europe / epidemiology
  • Female
  • Hospitals, Special
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Registries
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Sex Factors
  • United States / epidemiology
  • Vascular Calcification / complications*
  • Vascular Calcification / diagnostic imaging
  • Vascular Calcification / epidemiology
  • Vascular Calcification / etiology