Abstract
Patients with diabetes have a high prevalence of subclinical coronary artery disease (CAD). Our purpose is to study the coronary artery characteristics in diabetic patients. We performed coronary computed tomographic angiography in 374 patients without known CAD. We divided these patients into those with diabetes (diabetes group, n=138) and those without diabetes (nondiabetes group, n=236). We compared coronary calcium score (CCS), prevalence of significant stenosis, coronary plaque, and high-risk plaque (positive remodeling and low attenuation plaque) between the two groups. Patient characteristics were not significantly different between the two groups. The CCS was significantly higher in diabetes group than in nondiabetes group (median with 95% confidence interval [CI] 202, 95% CI: 7.5-673 vs. 60, 95%CI: 0-291, p=0.0002). The prevalence of significant stenosis (17.4% vs. 6.8%, p=0.0014) and coronary plaques (4.3±4.3 vs. 3.1±4.4, p=0.0089) were significantly higher in diabetes group compared with nondiabetes group. The prevalence of high-risk plaque (9.4% vs. 9.7%, p=0.92) was not significantly different between the two groups. However, in a multiple logistic regression analysis adjusted for variables associated with a high-risk plaque, only diabetes were significantly associated with a high-risk plaque. Our results showed that diabetic patients had higher CCS, higher prevalence of significant stenosis, and coronary plaque compared with nondiabetic patients. Moreover, diabetes was significantly associated with the presence of high-risk plaque by multivariate analysis.
Highlights
Patients with type 2 diabetes have a two- to four-fold higher risk of a cardiovascular event than nondiabetic patients (Redberg et al, 2002)
Our results showed that diabetic patients had higher calcium score (CCS), higher prevalence of significant stenosis, and coronary plaque compared with nondiabetic patients
Laboratory data showed that the value of blood sugar and glycated hemoglobin were significantly higher, and total cholesterol and LDL-cholesterol were significantly lower in diabetes group
Summary
Patients with type 2 diabetes have a two- to four-fold higher risk of a cardiovascular event than nondiabetic patients (Redberg et al, 2002). Previous studies have shown that the risk of myocardial infarction in a diabetic patient is comparable to the risk of recurrent infarction in a nondiabetic patient with a previous myocardial infarction (Haffner et al, 1998). 65% to 75% of diabetic patients die of cardiovascular disease (Libby et al, 2005). There is a clear need to identify diabetic patients who are at risk of cardiovascular events before the onset of symptoms. Coronary computed tomographic angiography (CCTA) emerged as a promising modality to evaluate coronary artery disease (CAD) noninvasively. Its ability to assess obstructive coronary artery disease has been demonstrated to be excellent compared with conventional coronary angiography (Hamon et al, 2006, Abdulla et al, 2007). Its ability to detect coronary plaques and characterize plaque composition has been well appreciated (Schroeder et al, 2001, Achenbach et al, 2004, Leber et al, 2005, Carrascosa et al, 2006)
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