Increased high-risk coronary plaque burden is associated with arterial stiffness in patients with type 2 diabetes without clinical signs of coronary artery disease

Abstract

Arterial stiffness and subclinical coronary atherosclerosis may yield valuable information on cardiovascular risk. We aimed to characterize coronary atherosclerosis in asymptomatic patients with type 2 diabetes and healthy controls and to investigate the association between baseline arterial stiffness and coronary plaque volumes after 5-year follow-up. Data from 45 patients and 61 matched controls were available for coronary plaque assessment. For analysis including carotid-femoral pulse wave velocity (PWV), 43 patients and 55 controls were available. At follow-up, mean (SD) age of participants was 63 ± 10 years, and mean diabetes duration (SD) in the patient group was 7.8 ± 1.4 years. Arterial stiffness (PWV) was assessed by tonometry at both visits. Total, calcified, noncalcified, low-density noncalcified coronary plaques volumes and other plaque characteristics were assessed by coronary computed tomography angiography at follow-up. Despite of similar or better blood pressure and plasma lipid control, patients had, compared with controls, a higher number of plaques with spotty calcifications (P < 0.01) and remodeling index more than 1.1 (P < 0.05), larger calcified plaque volumes [patients vs. 11 (0-65) vs. 3 (0-30) μl (P = 0.03)] and higher PWV [patients vs. controls at baseline: 9.1 ± 2.2 vs. 7.9 ± 1.4 m/s (P < 0.01), at follow-up: 9.3 ± 2.3 vs. 8.4 ± 1.8 m/s (P = 0.02)]. Baseline PWV was associated with volumes of all plaque types in crude analysis (P < 0.01) and with low-density noncalcified plaque volume in analysis adjusted for age, sex, diabetes and blood pressure (P = 0.01). Coronary plaques with unfavorable characteristics are more prevalent in well controlled asymptomatic patients with type 2 diabetes compared with healthy controls and independently associated with arterial stiffness.Clinical trials registration number: NCT02001532.