Evidence map›Paper›PMID 40782222›Full record

ArticleEuropean radiology2026

Use of CT-derived non-cardiovascular calcification marker for predicting cardiovascular events among diabetic older adults: the multi-ethnic study of atherosclerosis.

Elena Ghotbi, David A Bluemke, Quincy A Hathaway, Joshua G Klein, Mahsima Shabani, Sepehr Akhtarkhavari, R Graham Barr, Michael P Bancks, Wendy S Post, Matthew Budoff and 2 more

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Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Elena GhotbiDepartment of Radiology and Radiologic Sciences, Johns Hopkins University, Baltimore, MD, USA.
David A BluemkeDepartment of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.
Quincy A HathawayDepartment of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
Joshua G KleinDepartment of Radiology and Radiologic Sciences, Johns Hopkins University, Baltimore, MD, USA.
Mahsima ShabaniDepartment of Radiology and Radiologic Sciences, Johns Hopkins University, Baltimore, MD, USA.
Sepehr AkhtarkhavariDepartment of Radiology and Radiologic Sciences, Johns Hopkins University, Baltimore, MD, USA.
R Graham BarrDepartment of Medicine, Columbia University Medical Center, New York, NY, USA.
Michael P BancksWake Forest University School of Medicine, Winston-Salem, NC, USA.
Wendy S PostDivision of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Matthew BudoffLundquist Institute at Harbor-University of California Los Angeles School of Medicine, Torrance, CA, USA.
João A C LimaDivision of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Shadpour DemehriDepartment of Radiology and Radiologic Sciences, Johns Hopkins University, Baltimore, MD, USA. demehri2001@yahoo.com.ORCID http://orcid.org/0000-0001-6398-8448

Funding

Pulmonary Vascular Changes in Early Chronic Obstructive Pulmonary Disease (COPD)R01HL093081 · NHLBI · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI R Graham BARR · 2008 to 2026
$17.2M
Effect of statin intake on Non-traumatic Generalized Knee OsteoarthritisR01AR079620 · NIAMS · JOHNS HOPKINS UNIVERSITY · PI DEMEHRI, SHADPOUR · 2021 to 2025
$1.8M
NCATS NIH HHS UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420NHLBI NIH HHS 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169NHLBI NIH HHS R01 HL093081NIAMS NIH HHS R01 AR079620
6 · The paper itself

Abstract

objectiveTo evaluate the discriminative power of coronary artery calcium (CAC) score-based Cox models for predicting cardiovascular disease (CVD) in older adults with longstanding diabetes, a population at elevated CVD risk. We also aimed to determine whether adding computed tomography (CT)-derived costal cartilage calcification (CCC) improves risk prediction, given the potential limitation of CAC due to widespread soft tissue calcification. MATERIALS AND

methodsWe analyzed adults ≥ 65 years from the multi-ethnic study of atherosclerosis with longstanding diabetes mellitus (DM, ≥ 5 years, n = 231) and compared them to non-DM participants (n = 1148). We evaluated CAC-based risk models (adjusted for Framingham Risk Score, race/ethnicity, and statin use) and assessed the impact of adding CCC on model performance using Cox proportional-hazards regression and Harrell's C-statistic to predict CVD and coronary heart disease (CHD) incidence. CHD events included fatal coronary events, resuscitated cardiac arrest, myocardial infarction, adjudicated angina, and revascularization with angina. CVD events encompassed CHD, stroke (excluding transient ischemic attack), cardiovascular death, or other atherosclerotic deaths.

resultsOver 8.7 years, CVD and CHD events occurred in 17% and 10% of DM participants and 11% and 5% of non-DM participants, respectively. In longstanding DM participants, doubling of CAC was associated with higher CVD risk (HR: 1.13; 95% CI: 1.01-1.26), with model discrimination improving from C-statistic 0.66 to 0.69 (p = 0.02) after adding CCC. For CHD, the corresponding HR was 1.05 (95% CI: 0.98-1.13), and the C-statistic rose from 0.65 to 0.69 (p = 0.04). In non-DM participants, CCC did not enhance model performance for either CVD or CHD (p > 0.5).

conclusionCCC, a measurable biomarker of non-cardiovascular calcification from any conventional CT, improves CVD and CHD risk prediction models' performance in older adults with longstanding DM. KEY POINTS: Question Coronary artery calcium (CAC) may have limited discriminative power for predicting cardiovascular outcomes in older adults with longstanding diabetes. Findings Costal cartilage calcification (CCC), a biomarker of non-cardiovascular calcification from CT, improves the prediction of cardiovascular disease and coronary heart disease risks in this population. Clinical relevance Incorporating CCC, which can be easily measured using existing CAC assessment tools on CT scans, into cardiovascular risk assessment could refine clinical decision-making and improve individualized risk stratification in older adults with longstanding diabetes.

Indexed as

AtherosclerosisCalcinosisCardiovascular DiseasesCoronary Artery DiseaseDiabetes MellitusTomography, X-Ray ComputedVascular CalcificationAgedAged, 80 and overFemaleHumansMalePredictive Value of TestsProportional Hazards ModelsRisk AssessmentRisk FactorsCardiovascular diseaseCostal cartilageDiabetes mellitusTomography (X-ray computed)Vascular calcification

Identifiers

PMID40782222

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.