Accepted Manuscript Ascending and Descending Thoracic Aorta Calcification in Type 2 Diabetes Mellitus Timothy W. Churchill, MD, Suraj P. Rasania, MD, Hashmi Rafeek, MD, Claire K. Mulvey, MD, Karen Terembula, BS, Victor Ferrari, MD, Saurabh Jha, MD, Scott M. Lilly, MD, PhD, Luis H. Eraso, MD, Muredach P. Reilly, MB, MSCE, Atif N. Qasim, MD, MSCE PII:
S1934-5925(15)00151-3
DOI:
10.1016/j.jcct.2015.04.008
Reference:
JCCT 800
To appear in:
Journal of Cardiovascular Computed Tomograph
Received Date: 30 January 2014 Revised Date:
24 February 2015
Accepted Date: 18 April 2015
Please cite this article as: Churchill TW, Rasania SP, Rafeek H, Mulvey CK, Terembula K, Ferrari V, Jha S, Lilly SM, Eraso LH, Reilly MP, Qasim AN, Ascending and Descending Thoracic Aorta Calcification in Type 2 Diabetes Mellitus, Journal of Cardiovascular Computed Tomograph (2015), doi: 10.1016/ j.jcct.2015.04.008. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Ascending and Descending Thoracic Aorta Calcification in Type 2 Diabetes Mellitus Short Title: Calcification of the Thoracic Aorta in Diabetes
RI PT
Timothy W. Churchill, MD1, Suraj P. Rasania, MD2, Hashmi Rafeek, MD3, Claire K. Mulvey, MD4, Karen Terembula, BS3, Victor Ferrari, MD3, Saurabh Jha, MD5, Scott M. Lilly, MD, PhD3, Luis H. Eraso, MD6, Muredach P. Reilly, MB, MSCE3, Atif N. Qasim, MD, MSCE7 1
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M AN U
SC
Brigham and Women’s Hospital, Department of Medicine: 75 Francis St, Boston, MA, 02115 2 Geisinger Medical Center, Department of Cardiovascular Medicine: 100 North Academy Ave, Danville, PA 17821 3 Hospital of the University of Pennsylvania, Division of Cardiology: 3400 Spruce St, Philadelphia, PA 19104 4 University of California, San Francisco, Division of Internal Medicine: 505 Parnassus Ave, San Francisco, CA, 94143 5 Hospital of the University of Pennsylvania, Department of Radiology: 3400 Spruce St, Philadelphia, PA 19104 6 Thomas Jefferson University Hospital, Jefferson Vascular Center: 111 S. 11th St, Philadelphia, PA, 19107 7 University of California, San Francisco, Division of Cardiology: 505 Parnassus Ave, San Francisco, CA, 94143
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The Penn Diabetes Heart Study was supported by Clinical and Translational Science Award (UL1RR024134) from the National Center for Research Resources and a Diabetes and Endocrine Research Center award (P20-DK 019525), both from the National Institute of Health to University of Pennsylvania, as well as research grants from GlaxoSmithKline and Merck Research Laboratories (to MPR). All other authors have no industry relationships or conflicts of interest to disclose. Corresponding Author: Atif N. Qasim Box 0124 505 Parnassus Ave, Moffitt, 1177B University of California, San Francisco San Francisco, CA 94143 Phone: (650) 502 0329 Fax: (650) 353 9190 Email: [email protected]
1
ACCEPTED MANUSCRIPT
Abstract Background: Calcification of the thoracic aorta is a risk factor for cardiovascular disease and peripheral arterial disease, but has not been well studied in diabetics. In
RI PT
addition, many studies consider aortic calcium as a single anatomic entity, whereas calcification of the ascending and descending portions of the thoracic aorta may represent separate phenotypes. We sought to characterize the prevalence of ascending
SC
and descending aortic calcium among diabetics and to assess their associations with cardiovascular risk factors, coronary artery calcium, and peripheral arterial disease.
M AN U
Methods & Results: Within the Penn Diabetes Heart Study, a cross-sectional study of subjects with type 2 diabetes mellitus but without coronary or renal disease, we quantified Agatston scores of the ascending and descending thoracic aorta in 1,739 subjects (63% male, 61% Caucasian). Multivariable logistic and tobit regression were
TE D
used to assess associations with cardiovascular risk factors, coronary calcium, and peripheral arterial disease. Out of all subjects, 54% had thoracic aortic calcium; of these, 37% had calcium solely in the ascending thoracic aorta and 20% solely in the
EP
descending thoracic aorta. In multivariable regression, age, Caucasian race, systolic blood pressure, LDL cholesterol, smoking, and diabetes duration were independently
AC C
associated with calcium of both the ascending and descending thoracic aorta (p0.8. Interclass correlation coefficients
respectively.
EP
for both ascending and descending aortic calcium Agatston scores were 0.97 and 0.99
AC C
Statistical Analysis
Demographic variables and cardiovascular risk factors were assessed among subjects with and without thoracic aortic calcium, using the χ2 test, unpaired t-test and the ranksum tests. A multivariate model was constructed using variables significant in univariate analysis (p
S1934-5925(15)00151-3
DOI:
10.1016/j.jcct.2015.04.008
Reference:
JCCT 800
To appear in:
Journal of Cardiovascular Computed Tomograph
Received Date: 30 January 2014 Revised Date:
24 February 2015
Accepted Date: 18 April 2015
Please cite this article as: Churchill TW, Rasania SP, Rafeek H, Mulvey CK, Terembula K, Ferrari V, Jha S, Lilly SM, Eraso LH, Reilly MP, Qasim AN, Ascending and Descending Thoracic Aorta Calcification in Type 2 Diabetes Mellitus, Journal of Cardiovascular Computed Tomograph (2015), doi: 10.1016/ j.jcct.2015.04.008. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT
Ascending and Descending Thoracic Aorta Calcification in Type 2 Diabetes Mellitus Short Title: Calcification of the Thoracic Aorta in Diabetes
RI PT
Timothy W. Churchill, MD1, Suraj P. Rasania, MD2, Hashmi Rafeek, MD3, Claire K. Mulvey, MD4, Karen Terembula, BS3, Victor Ferrari, MD3, Saurabh Jha, MD5, Scott M. Lilly, MD, PhD3, Luis H. Eraso, MD6, Muredach P. Reilly, MB, MSCE3, Atif N. Qasim, MD, MSCE7 1
TE D
M AN U
SC
Brigham and Women’s Hospital, Department of Medicine: 75 Francis St, Boston, MA, 02115 2 Geisinger Medical Center, Department of Cardiovascular Medicine: 100 North Academy Ave, Danville, PA 17821 3 Hospital of the University of Pennsylvania, Division of Cardiology: 3400 Spruce St, Philadelphia, PA 19104 4 University of California, San Francisco, Division of Internal Medicine: 505 Parnassus Ave, San Francisco, CA, 94143 5 Hospital of the University of Pennsylvania, Department of Radiology: 3400 Spruce St, Philadelphia, PA 19104 6 Thomas Jefferson University Hospital, Jefferson Vascular Center: 111 S. 11th St, Philadelphia, PA, 19107 7 University of California, San Francisco, Division of Cardiology: 505 Parnassus Ave, San Francisco, CA, 94143
AC C
EP
The Penn Diabetes Heart Study was supported by Clinical and Translational Science Award (UL1RR024134) from the National Center for Research Resources and a Diabetes and Endocrine Research Center award (P20-DK 019525), both from the National Institute of Health to University of Pennsylvania, as well as research grants from GlaxoSmithKline and Merck Research Laboratories (to MPR). All other authors have no industry relationships or conflicts of interest to disclose. Corresponding Author: Atif N. Qasim Box 0124 505 Parnassus Ave, Moffitt, 1177B University of California, San Francisco San Francisco, CA 94143 Phone: (650) 502 0329 Fax: (650) 353 9190 Email: [email protected]
1
ACCEPTED MANUSCRIPT
Abstract Background: Calcification of the thoracic aorta is a risk factor for cardiovascular disease and peripheral arterial disease, but has not been well studied in diabetics. In
RI PT
addition, many studies consider aortic calcium as a single anatomic entity, whereas calcification of the ascending and descending portions of the thoracic aorta may represent separate phenotypes. We sought to characterize the prevalence of ascending
SC
and descending aortic calcium among diabetics and to assess their associations with cardiovascular risk factors, coronary artery calcium, and peripheral arterial disease.
M AN U
Methods & Results: Within the Penn Diabetes Heart Study, a cross-sectional study of subjects with type 2 diabetes mellitus but without coronary or renal disease, we quantified Agatston scores of the ascending and descending thoracic aorta in 1,739 subjects (63% male, 61% Caucasian). Multivariable logistic and tobit regression were
TE D
used to assess associations with cardiovascular risk factors, coronary calcium, and peripheral arterial disease. Out of all subjects, 54% had thoracic aortic calcium; of these, 37% had calcium solely in the ascending thoracic aorta and 20% solely in the
EP
descending thoracic aorta. In multivariable regression, age, Caucasian race, systolic blood pressure, LDL cholesterol, smoking, and diabetes duration were independently
AC C
associated with calcium of both the ascending and descending thoracic aorta (p0.8. Interclass correlation coefficients
respectively.
EP
for both ascending and descending aortic calcium Agatston scores were 0.97 and 0.99
AC C
Statistical Analysis
Demographic variables and cardiovascular risk factors were assessed among subjects with and without thoracic aortic calcium, using the χ2 test, unpaired t-test and the ranksum tests. A multivariate model was constructed using variables significant in univariate analysis (p
