Difference of coronary artery disease severity, extent and plaque characteristics between patients with hypertension, diabetes mellitus or dyslipidemia.

Abstract

The purpose of this study was to investigate the difference of coronary artery disease (CAD) severity and extent as well as plaque characteristics between patients with either one of hypertension (HT), diabetes mellitus (DM) or dyslipidemia (DL). We retrospectively reviewed the records of 1,161 patients (HT 442, DM 77, DL 248, no disease 394) who underwent coronary computed tomography angiography. Stenosis severity was classified as normal, non-obstructive (1-49% stenosis), moderate (50-69% stenosis) or severe (≥70% stenosis). Segment involvement score (SIS) and segment severity score (SSS) was calculated. We defined patients at risk as patients with obstructive CAD or non-obstructive CAD with extensive disease (SIS ≥5). Plaque characteristics were evaluated including positive remodeling, low attenuation and spotty calcification. Obstructive CAD was most frequent in DM patients, followed by HT and DL patients (34, 19 and 15%, respectively, p<0.0001). DM patients had more extensive disease than HT and DL patients (SIS 3.1 vs 2.1 vs 1.4, SSS 4.0 vs 2.7 vs 2.0). DM patients were more at risk than HT and DL patients (p<0.05). The prevalence of positive remodeling, low attenuation and spotty calcium were all highest in DM patients (p<0.005, vs HT and DL), while low attenuation was more frequent in DL than HT patients (p<0.005). The median calcium score of HT and DM patients were higher than DL patients (p<0.01 and p<0.005, respectively), while no significant difference was observed between HT and DM patients. In conclusion,DM patients possessed more high risk plaque and obstructive as well as extensive CAD compared with HT and DL patients. Coronary calcification was similarly high in HT and DM patients. Low attenuation plaque was more frequent in DL than HT patients.