Abdominal Aortic Calcification in Type 2 Diabetes: Association with Coronary Heart Disease and Performance of a Clinical Model

Abstract

Type 2 diabetes mellitus (T2DM) is associated with an accelerated development of atherosclerotic vascular disease, which accounts for most of its cardiovascular complications. Abdominal aortic calcification (AAC) has been proposed as a marker of cardiovascular risk. The aim of this study was to describe the clinical and therapeutic profile of patients with T2DM and to evaluate the association between AAC and macrovascular complications. Materials and methods: Cross-sectional observational study of 209 adults with T2DM. Demographic, clinical, and biochemical variables were recorded, and micro- and macrovascular complications were documented. AAC was assessed on 118 interpretable lateral lumbar spine radiographs using the Kauppila score. The association between AAC and ischemic heart disease (IHD) was analyzed with logistic regression (age-adjusted model and parsimonious model). Results: Women comprised 56% of the cohort; median age was 62 years, T2DM duration 8 years, and median HbA1c 7.1%. Macrovascular complications occurred in 16.7%: IHD 9.6%, cerebrovascular disease 2.9%, and peripheral arterial disease 6.2%. AAC was present in 30.5% and was more frequent among those with IHD (66.7% vs. 26.4%; p=0.004). In the age-adjusted model, AAC showed a trend toward association with IHD (OR 3.44; 95% CI 0.883–13.40; p=0.075). In the parsimonious model, AAC remained an independent predictor (OR 5.25; 95% CI 1.42–19.40; p=0.0128). Model performance: AUC 0.81 (95% CI 0.71–0.91), good calibration (Hosmer-Lemeshow p=0.246), and Brier score 0.081. Discussion: In T2DM, AAC was associated with a higher probability of IHD and may serve as an accessible marker of subclinical cardiovascular risk. Prospective studies are warranted to confirm causality and define its prognostic utility.