Endocrine Abstracts

Background: People with type 2diabetes (T2D) often referred as cardiovascular disease (CVD) risk equivalent. However, CVD risk in diabetes varies greatly and substantial proportion of people with T2D have low CVD risk as with the general healthy population. The latest European Society of Cardiology (ESC) guidelines 2023 endorsed the T2D-specific CVD risk score (SCORE2-Diabetes) for people with T2D. However, current prediction models are developed from non-Asian populations, and their utility in other parts of the world is unknown.

Objectives: This study aims to compare various CVD risk prediction tools and validate their performances with the severity of subclinical coronary atherosclerosis assessed by coronary artery calcium (CAC) risk scoring system in asymptomatic Thai people with T2D.

Methods: This cross-sectional study included asymptomatic Thai people with DM who underwent CAC measurement at Theptarin Hospital, Bangkok, Thailand. Four CV risk scores (Thai CV risk score, SCORE2 model, SCORE2-Diabetes model, and UKPDS risk score) were applied and estimated risk scores were correlated with the severity of CAC. Both low-risk and moderate-risk countries were applied in SCORE2 and SCORE2-Diabetes models.

Results: A total of 83 participants (female 39.8%, mean age 59.0±7.2 years, mean DM duration 10.0±8.9 years, BMI 26.5±5.1 kg/m², A1C 7.3±1.7%, insulin usage 24.1%) were studied. Zero calcium score was found in 25.3% and CAC score ≥ 100 AU was found in 49.4% of all participants. In people with a duration of diabetes ≥ 10 years, zero calcium score was also found in 6.1%. The Thai CV risk score classified the highest proportion of patients into very high-risk category of CVD (28.9%), followed by SCORE2 (9.6%), SCORE2-Diabetes (9.6%), and UKPDS (7.2%). Spearman correlation coefficients for CAC score with various CV scores ranged from 0.314 to 0.419 with SCORE2-Diabetes performed the best.

Conclusions: Our data showed that when CAC measurements were done in asymptomatic people with DM, almost one-fourth of subjects were found to have zero score, indicating very low-risk for CVD in the future. Although there had been many efforts to create CV risk scoring systems both general population and diabetes-specific risk scores for CVD risk stratification, currently available CVD risk scores (both non-DM and DM-specific risk scores) did not accurately predict the severity of CAC burden in Thai people with T2D.