The diabetes conundrum: despite increasing incidences of coronary disease in diabetic type II patients, their first cathlab presentation is later than expected

Abstract

This editorial refers to ‘Severity of coronary atherosclerosis in patients with a first acute coronary event: a diabetes paradox’[†][1], by M. Niccoli et al. , on page 729 Niccoli et al . assessed the severity of coronary artery disease (CAD) in the culprit vessels of diabetic type II as well as non-diabetic patients ( n = 167) at the time of their first coronary event employing standard coronary angiography and intracoronary optical coherence tomography (OCT) imaging ( n = 72).1 To assess the severity of CAD, they applied the Bogarty, Gensini, and Sullivan scores, and to evaluate the development of collaterals they used the Rentrop score, all based on coronary angiography. Intracoronary imaging by OCT was performed to study coronary plaque morphology, more particularly to quantify the amount of lipids and calcification present in the plaques. This was assessed at the site of the minimal lumen area (MLA) and at the cross-section showing the largest arc of calcium in the culprit vessel. Furthermore, the OCT images were inspected for the presence of calcified nodules.2 The findings of the authors are: more collateral development towards the culprit vessel, less lipids at the MLA site, more severe calcified segments, and more superficial calcified nodules in diabetic type II patients as compared with non-diabetics at the time of their first event. As the author's state: despite more severe coronary calcification, including calcified nodules, potent pro-inflammatory, pro-oxidant, and pro-thrombotic stimuli in diabetic type II patients, these patients seem to experience their first event at a later stage in the process of CAD as compared with non-diabetic patients. This finding is seemingly at odds with general convention, i.e. that the first event for all patients happens at the same stage of CAD. The authors hypothesized that there might be, besides an increased presence … [1]: #fn-2