IMPACT OF CARDIOVASCULAR RISK AND HYPERTENSION ON SUBCLINICAL CORONARY ATHEROSCLEROSIS IN ASYMPTOMATIC DIABETIC INDIVIDUALS

Abstract

Objective: This study sought to evaluate the effect of 10-year ASCVD (Atherosclerotic Cardiovascular Disease) risk and blood pressure (BP) on subclinical coronary atherosclerosis in asymptomatic diabetic individuals. Design and method: We analyzed 739 asymptomatic diabetic individuals (mean age 55.5 ± 7.3 years; 541 [73.2%] men) with no prior history of coronary artery disease who voluntarily underwent coronary computed tomography angiography (CCTA) as part of a general health examination. The classification of BP was adapted from the American College of Cardiology/American Heart Association 2017 guideline. Study participants were categorized as low (<15%) and high ASCVD risk (> = 15%) groups, respectively. Subclinical coronary atherosclerosis was defined as the presence of any coronary plaque by CCTA. Results: In subjects with low ASCVD risk (n = 498), after adjustment for cardiovascular risk factors, subclinical coronary atherosclerosis was not associated with elevated BP, stage 1, and stage 2 hypertension groups compared with normal BP group (P for all > 0.05). On the other hand, in subjects with high ASCVD risk (n = 241), there was no statistically difference in the adjusted odds ratios of both elevated BP (adjusted odds ratio [aOR] 2.068; 95% confidence interval [CI], 0.703–6.080; P = 0.187) and stage 1 hypertension groups (aOR, 1.533; 95% CI, 0.679–3.459; P = 0.304) for the presence of any coronary plaque. However, the stage 2 hypertension group had a significant association with subclinical coronary atherosclerosis (aOR, 4.127; 95% CI, 1.592–10.696; P = 0.004). Conclusions: In asymptomatic diabetic individuals with low ASCVD risk, BP levels were not associated with an increased risk of subclinical coronary atherosclerosis. However, in those with high ASCVD risk, stage 2 hypertension was only associated with an increased risk of subclinical coronary atherosclerosis. These results suggest that hypertension management may be different in diabetic individuals according to the their ASCVD risk.