In this issue of Diabetes Care, Bernstein (1) raises an interesting question regarding the potential contribution of medial calcification to coronary artery calcium scores in diabetic patients. Although such calcification is common in the muscular arteries of the legs of patients with longstanding diabetes, it is much less frequently found in visceral arteries and has only rarely been reported in coronary arteries (2). Diabetic patients have been included in numerous studies comparing coronary artery calcium scores with coronary artery atherosclerosis burden, and no differences have been found compared with nondiabetic patients. Finally, in a recent publication (3) focused specifically on diabetic patients, coronary artery calcium score, as detected by electron beam tomography, was strongly correlated with clinical coronary artery disease. The above considerations provide a sound basis for utilizing coronary artery calcium as a marker for coronary atherosclerosis in diabetic patients.

1
Bernstein RK: Increased prevalence of significant coronary artery calcification in patients with diabetes (Letter).
Diabetes Care
24
:
1509
,
2001
2
Lachman AS, Spray TL, Kerwin DM, Shugoll GI, Roberts WC: Medial calcinosis of Monckeberg: a review of the problem and a description of a patient with involvement of peripheral, visceral and coronary arteries.
Am J Med
63
:
615
–622,
1977
3
Olson JC, Edmundowicz D, Becker DJ, Kuller LH, Orchard TJ: Coronary calcium in adults with type 1 diabetes: a stronger correlate of clinical coronary artery disease in men than in women.
Diabetes
49
:
1571
–1578,
2000

Address correspondence to Dr. Theodore Mazzone, Rush Medical Center, 1653 W. Congress Pkwy., Chicago, IL 60612. E-mail: tmazzone@rush.edu.