{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:23:59Z","timestamp":1791231839691,"version":"4.1.0"},"reference-count":31,"publisher":"American Diabetes Association","issue":"4","license":[{"start":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T00:00:00Z","timestamp":1644883200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To assess lifetime cardiovascular disease (CVD) risk by coronary artery calcium (CAC) score in individuals with diabetes from the Multi-Ethnic Study of Atherosclerosis (MESA) and compare risk with that in individuals without diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We developed a microsimulation model with well, diabetes, post-CVD, and death health states using multivariable time-dependent Cox regression with age as time scale. We initially used 10-year follow-up data of 6,769 MESA participants, including coronary heart disease (CHD) (n = 272), heart failure (n = 201), stroke (n = 186), and competing death (n = 619) and assessed predictive validity at 15 years. We externally validated the model in matched National Health and Nutrition Examination Survey (NHANES) participants. Subsequently, we predicted CVD risk until age 100 years by diabetes, 10-year pooled cohort equations risk, and CAC score category (0, 1\u2013100, or 100+).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The model showed good calibration and discriminative performance at 15 years, with discrimination indices 0.71\u20130.78 across outcomes. In the NHANES cohort, predicted 15-year mortality risk corresponded well with Kaplan-Meier risk, especially for those with diabetes: 29.6% (95% CI 24.9\u201334.8) vs. 32.4% (95% CI 27.2\u201337.2), respectively. Diabetes increased lifetime CVD risk, similar to shifting one CAC category upward (from 0 to 1\u2013100 or from 1\u2013100 to 100+). Patients with diabetes and CAC score of 0 had a lifetime CVD risk that overlapped with that of individuals without diabetes who were at low 10-year pooled cohort equations risk (&amp;lt;7.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Patients with diabetes carry a spectrum of CVD risk. CAC scoring may improve decisions for preventive interventions for patients with diabetes by better delineating lifetime CVD risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc21-1607","type":"journal-article","created":{"date-parts":[[2022,2,15]],"date-time":"2022-02-15T17:17:11Z","timestamp":1644945431000},"page":"975-982","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":20,"title":["Lifetime Cardiovascular Disease Risk by Coronary Artery Calcium Score in Individuals With and Without Diabetes: An Analysis From the Multi-Ethnic Study of Atherosclerosis"],"prefix":"10.2337","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2754-545X","authenticated-orcid":false,"given":"Bart S.","family":"Ferket","sequence":"first","affiliation":[{"name":"Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.G. Myriam","family":"Hunink","sequence":"additional","affiliation":[{"name":"Departments of Epidemiology and Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands"},{"name":"Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3269-804X","authenticated-orcid":false,"given":"Umesh","family":"Masharani","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Max","sequence":"additional","affiliation":[{"name":"Institute for Health & Aging and Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6274-5882","authenticated-orcid":false,"given":"Joseph","family":"Yeboah","sequence":"additional","affiliation":[{"name":"Heart and Vascular Center of Excellence, Wake Forest Baptist Health, Winston Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory L.","family":"Burke","sequence":"additional","affiliation":[{"name":"Division of Public Health, Wake Forest School of Medicine, Winston Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3813-4384","authenticated-orcid":false,"given":"Kirsten E.","family":"Fleischmann","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2022,2,15]]},"reference":[{"key":"2022032917210571800_B1","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.jacc.2018.05.027","article-title":"Coronary calcium score and cardiovascular risk","volume":"72","author":"Greenland","year":"2018","journal-title":"J Am Coll 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