Type 2 Diabetes Mellitus and Atherosclerotic Cardiovascular Disease: Can the Coronary Artery Calcium Score Improve Risk Stratification and Management?

Authors

• Allison M. Holt, University of LynchburgFollow

Advisor

Dr. Sarah Bolander

Abstract

ABSTRACT

Diabetes affects over 830 million people worldwide, including 38.4 million in the United States, and atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality in this population. Traditional ASCVD risk assessment tools – such as ASCVD risk calculator, Predicting Risk of Cardiovascular Disease EVENTs (PREVENT), and Framingham risk score (FRS) – are widely recognized but have limitations in diverse populations.  This review evaluates whether incorporating the coronary artery calcium (CAC) score, compared with traditional tools, improves ASCVD risk stratification and management in asymptomatic patients with type 2 diabetes. Evidence shows that the CAC scoring is at least equivalent – and often superior – to traditional risk models in predicting ASCVD events, offering more precise classification of both high – and low – risk individuals. Notably, individuals with CAC = 0 demonstrate very low short – to intermediate – term event rates.  Incorporating CAC scoring may refine statin and aspirin decisions, reduce unnecessary pharmacologic burden in patients with CAC = 0, and improve patient adherence by providing a tangible measure of risk.  Limitations include population diversity, cost, accessibility, equity concerns, and radiation exposure.  Future research should focus on randomized controlled trials comparing CAC-guided strategies to traditional tools, long-term prognostic studies, cost-effectiveness analyses, and evaluations of equity and optimal scanning intervals.  Integrating the CAC score into routine risk assessment may improve individualized management and improve cardiovascular outcomes in patients with type 2 diabetes.

Recommended Citation

Holt AM. Type 2 Diabetes Mellitus and Atherosclerotic Cardiovascular Disease: Can the Coronary Artery Calcium Score Improve Risk Stratification and Management?. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).