ArticleThe international journal of cardiovascular imaging2026
Coronary artery calcium score of zero in individuals with diabetes: association with normal coronary arteries and cardiovascular risk factors.
Article in The international journal of cardiovascular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Diabetes mellitus (DM) is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD). Using data from coronary calcium scans and coronary computed tomography angiography (CCTA), we aim to identify the prevalence of normal coronary arteries in individuals with DM with a coronary arterial calcium (CAC) score of zero and to characterize the risk factors associated with this score.We performed a retrospective study of patients with DM who underwent CAC and CCTA screenings from October 2004 to January 2024 at our center in Torrance, California. We compared plaque severity and risk factor data between those with CAC = 0 and > 0.In a cohort of 2,763 individuals with DM, the mean age was 63.8 ± 12.2 years, and 62% were male. Of these, 465 subjects (17%) had CAC = 0. The remaining 2,298 had CAC > 0 with a median CAC score of 428 (interquartile range [IQR]: 91-1267). Subjects with CAC = 0 were younger than those with CAC > 0 (53.0 ± 13.9 versus 66.0 ± 10.6 years; p < 0.001), more likely female, and had lower prevalence of hypertension (57% versus 76%; p < 0.001) and hyperlipidemia (63% versus 76%; p < 0.001). Among DM subjects with a CAC = 0, 133 individuals (29%) had a total plaque severity score of > 0 (median: 1, IQR: 1-2) while 332 subjects (71%) showed normal coronary arteries on CCTA.A significant percentage of DM subjects had CAC = 0. DM subjects with CAC = 0 were not necessarily free of non-calcified plaque burden. Subjects with CAC = 0 tended to be younger, female, and absent of hypertension and hyperlipidemia.
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