2型糖尿病患者患心血管疾病的风险是非糖尿病人群的两到四倍。冠状动脉钙化（CAC）测试有助医生预测哪些糖尿病患者心脏疾病的风险最大，根据维克森林大学浸信会医疗中心的一项研究。

　　目前医学界的指南推荐将所有糖尿病患者视为心血管疾病高风险人群，但维克森林浸信会的这项研究发现，CAC可以识别致命性心血管疾病高风险以及低风险的糖尿病患者。

　　"我们的研究结果挑战了公认的医学看法，即所有糖尿病患者心血管风险相同。CAC是预测不同风险水平的关键，"Donald Bowden博士，维克森林大学浸信会生物化学教授和资深作者。研究结果在线发表于十二月号刊《糖尿病护理》（Diabetes Care）杂志。

　　研究总共纳入1123名34-86岁2型糖尿病患者，平均随访7.4年。这项研究的受试者来自北卡罗来纳州西部的诊所。

　　"高风险人群死于心血管疾病的风险是低风险人群的11倍。更精确的诊断风险水平可帮助医生提供更有效的治疗，并有望改善的结果，"研究人员说。

　　Coronary Calcium Score Predicts Cardiovascular Mortality in Diabetes

　　Subhashish Agarwal, Amanda J. Cox, David M. Herringto,et al

　　Abstract

　　OBJECTIVE

　　In type 2 diabetes mellitus (T2DM), it remains unclear whether coronary artery calcium (CAC) provides additional information about cardiovascular disease (CVD) mortality beyond the Framingham Risk Score (FRS) factors.

　　RESEARCH DESIGN AND METHODS

　　A total of 1,123 T2DM participants, ages 34–86 years, in the Diabetes Heart Study followed up for an average of 7.4 years were separated using baseline computed tomography scans of CAC (0–9, 10–99, 100–299, 300–999, and ≥1,000).

　　Logistic regression was performed to examine the association between CAC and CVD mortality adjusting for FRS.

　　Areas under the curve (AUC) with and without CAC were compared. Net reclassification improvement (NRI) compared FRS (model 1) versus FRS+CAC (model 2) using 7.4-year CVD mortality risk categories 0% to <7%, 7% to <20%, and ≥20%.

　　RESULTS

　　Overall, 8% of participants died of cardiovascular causes during follow-up. In multivariate analysis, the odds ratios (95% CI) for CVD mortality using CAC 0–9 as the reference group were, CAC 10–99: 2.93 (0.74–19.55); CAC 100–299: 3.17 (0.70–22.22); CAC 300–999: 4.41(1.15–29.00); and CAC ≥1,000: 11.23 (3.24–71.00). AUC (95% CI) without CAC was 0.70 (0.67–0.73), AUC with CAC was 0.75 (0.72–0.78), and NRI was 0.13 (0.07–0.19).

　　CONCLUSIONS

　　In T2DM, CAC predicts CVD mortality and meaningfully reclassifies participants, suggesting clinical utility as a risk stratification tool in a population already at increased CVD risk.