Atherosclerotic coronary plaque in subjects with diabetic neuropathy: the prognostic cardiovascular role of Charcot neuroarthropathy—a case–control study

Abstract

The aim of this study was to investigate the severity of coronary artery disease (CAD) and the plaque composition in neuropathic type 2 diabetic subjects with and without Charcot neuroarthropathy (CN) undergoing multidetector computed tomography coronary angiography (MDCT-CA). The study was a single-center, observational, with unmatched case-control design. We selected 17 CN patients and 18 patients with diabetic neuropathy (DN) without CN. In all the patients, multidetector computed tomography was performed to assess the coronary artery calcium score (CACS) and degree of coronary artery stenosis. Patients were classified as positive in the presence of significant CAD if there was at least one stenosis >50 % on MDCT-CA. The invasive coronary angiography was performed in case of significant stenosis detected with MDCT-CA, both as reference to standard and eventually as treatment. Groups were matched for age, sex, and traditional CAD risk factors. As compared to DN individuals, CN exhibited higher rates of significant coronary stenoses (p = 0.027; OR 7.7 [1.3-43.5]). However, no significant differences were observed in the CACS, which reflects plaque burden, in the two groups (p = 0.759). No significant differences were observed comparing CACS distribution in all subjects for stenosis higher/equal or lower than 50 % (p = 0.320). Finally, no significant differences were observed comparing CACS distribution in CN and DN subjects for coronary stenoses higher/equal or lower than 50 %. Our results suggest that CN patients have a higher prevalence of severe coronary plaques compared to DN patients. Nevertheless, coronary plaques in CN patients did not exhibit an increased degree of calcification.

Atherosclerosis and Microvascular Complications: Results From the Canadian Study of Longevity in Type 1 Diabetes

“…Studies involving individuals with type 2 diabetes with a relatively short duration of disease also did not exhibit a relationship between CAC score and clinical neuropathy end points. In contrast, cardiac autonomic neuropathy was associated with CAC in participants with T1D who had a shorter duration of disease (mean duration 26 years) compared with participants in this study who had longer mean duration of disease (54 years) (23,24). To our knowledge, the current exploratory analysis suggests that both clinical and quantitative electrophysiological measures of neuropathy are associated with central atherosclerotic burden, as measured by CAC in the setting of long-standing T1D.…”

Autoantibodies to post‐translationally modified type I and II collagen in Charcot neuroarthropathy in subjects with type 2 diabetes mellitus

“…Charcot neuroarthropathy (CN) is a diabetic complication involving bones, joints, and soft tissues of the foot and ankle, potentially leading to dislocations, fractures, and deformity and associated with an increased cardiovascular risk . The pathogenic mechanisms behind CN are still unclear, and its etiology is supposed to be multifactorial .…”

MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy

“…Our study shows that patients with CN have a higher prevalence of severe CAD in comparison with DN, but their coronary plaques did not exhibit an increased degree of calcium. Recently there has been described [41] an hypothesis which could explain this higher coronary plaque burden in CN, mainly linked to an over-expression of inflammation with production of several cytokines [tumour necrosis factor-α (TNF-α), interleukin-1 (IL-1)] [42] and determining an endothelial dysfunction by promoting the expression of procoagulant molecules, selectins, vascular cell adhesion protein-1 (VCAM-1), and the intercellular adhesion molecule-1 (ICAM-1) [43,44]. Furthermore, the lack of differences regarding the CACS might be a further confirmation that neuropathy is not the only factor in the pathogenesis of CN.…”