Endocrine Abstracts

Introduction: Coronary calcification (quantified as Agatston’s calcium score (CS) and measured with a CT-based method) has been shown to predict coronary atherosclerotic burden and mortality in type 2 diabetics (T2D). Compared to a single measurement, the progression of CS in time better reflects the effects of cardiovascular risk factors that have not yet been fully elucidated.

Methods: We measured calcium score (CS) (Agatston’s method, 64-slice MDCT) in 45 T2D without renal disease (23 males, average ± SD for duration of diabetes 10±8 years, BMI 31±5) initially and after 18 months. We also measured HbA1c, femoral neck mineral bone density, blood pressure, serum calcium, phosphate, 25-OHD, intact PTH, fetuin-A, hsCRP, alkaline phosphatase, albumin, homocysteine, triglicerides, total, LDL and HDL cholesterol. Patients self-monitored preprandial and postprandial blood glucose (BG) (at least one day per week). We calculated Spearman’s correlation coefficients (for absolute and relative change in CS) and performed multiple linear regression (CS were ln-transformed for non-normality).

Results: Median (IQR) of CS at baseline was 63 (6-384), after 18 months 100 (13-532). Mean (±SD) preprandial BG was 7.84±0.85 mmol/l, postprandial BG 9.50±1.62, HbA1c 7.5±0.9%. Mean fetuin-A (for both measurements) was 26.8±5.0 ng/ml. We found significant correlations between absolute and relative change in CS and fetuin-A and relative change in CS (P 0.05). For other bivariate pairs P was >0.05. In multiple regression, based on postprandial BG and fetuin-A, both remained significant (R for model 0.497, F 5.941, P 0.006).

Conclusions: Postprandial BG and fetuin-A seem to be independently related to coronary calcification progression in T2D. Higher postprandial BG levels contribute to calcification progression. Higher fetuin-A appears to be protective in our patients, although further research is warranted.