Gender-based risk stratification of coronary artery disease in asymptomatic diabetic subjects: a multi-clinic study using multi-detector computed tomography

Abstract

Purpose: Patients with type 2 diabetes show a greater gender difference for associated risk of coronary artery disease (CAD), but the overall risk factor burden, including microvascular complications and glycemic control, has not been fully considered. This study aimed to clarify the incidence and severity of the gender difference for asymptomatic CAD and the gen der-linked predictors in patients with type 2 diabetes. Methods: In a multi-clinic group of diabetologists, 506 diabetic patients (320 men and 186 women) without known CAD or symptoms suggestive of CAD were recruited for 64-slice multi-detector computed tomography (MDCT). Patients were categorized according to severity of coronary atherosclerosis: Grade 1 (normal findings), Grade 2 (observation required), Grade 3 (coronary angiography [CAG] recommended), Grade 4 (percutaneous coronary intervention [PCI] possible, CAG potentially required), Grade 5 (CAG mandatory, PCI/coronary artery bypass graft [CABG] potentially required). Results: The trend for severity grade of coronary atherosclerosis was slightly higher in men than women (P=0.054). In men, Grade 1=17%, 2=39%, 3=24%, 4=17%, and 5=3%, and in women, Grade 1=28%, 2=35%, 3=22%, 4=12%, and 5=3.2%. There was a statistical difference in abnormal findings between men and women (82% vs. 72%; χ2=8.413, P=0.004), but for critical lesions (combined Grades 3, 4, and 5), the prevalence was almost equal between men and women (44% vs. 37%; χ2=2.512, P=0.113). Multivariate logistic regression models showed that in men, HbA1c ≥ 7.4%, dyslipidemia, duration of diabetes, any retinopathy, and other type of cardiovascular diseases were significant predictors of critical lesions and in women, duration of diabetes and any retinopathy were significant predictors. Conclusion: The incidence and severity of asymptomatic CAD are comparably high in men and women with type 2 diabetes. Gender-based risk stratification, including microangiopathy, duration of diabetes, and other risk factors can help predict asymptomatic coronary lesions.