Potential ImplicationsofCoronaryArtery Calcium Testing for Guiding Aspirin Use Among Asymptomatic Individuals With Diabetes

OBJECTIVEdIt is unclear whether coronary artery calcium (CAC) is effective for risk strat-ifying patients with diabetes in whom treatment decisions are uncertain. RESEARCH DESIGN ANDMETHODSdOf 44,052 asymptomatic individuals referred for CAC testing, we studied 2,384 individuals with diabetes. Subjects were followed for amean of 5.6 6 2.6 years for the end point of all-cause mortality. RESULTSdThere were 162 deaths (6.8%) in the population. CAC was a strong predictor of mortality across age-groups (age,50, 50–59, $60), sex, and risk factor burden (0 vs. $1 additional risk factor). In individuals without a clear indication for aspirin per current guidelines, CAC stratified risk, identifying patients above and below the 10 % risk threshold of presumed aspirin benefit. CONCLUSIONSdCAC can help risk stratify individuals with diabetes and may aid in selec-tion of patients who may benefit from therapies such as low-dose aspirin for primary prevention. Diabetes Care 35:624–626, 2012 A lthough diabetes has been con-sidered a coronary heart disease(CHD) risk equivalent (1), not all individuals with diabetes carry equivalen