Comparison of atherosclerotic plaque burden and composition between diabetic and non diabetic patients by non invasive CT angiography

Abstract

Type 2 diabetes mellitus (DM) is associated with a higher risk of cardiovascular disease and atherosclerotic burden. However little data exists in regards to plaque distribution and plaque composition in these patients. To assess for differences in the coronary plaques burden and composition among symptomatic patients with and without type 2 DM using multidetector computed tomography angiography (MDCTA). The 416 symptomatic patients (64% males, mean age: 61 +/- 13 years) with 61 (15%) reporting type 2 DM, who underwent contrast-enhanced MDCTA were studied. Enrolled patients had an intermediate to high pre-test probability of obstructive coronary artery disease. Multivariate analysis was used to correct for differences in age and gender. Patients with type 2 DM were more likely to have significant stenosis >or=70% in at least one coronary segments (33% in type 2 DM vs. 18% in non diabetic, P = 0.013), whereas 11% of both type 2 DM and non diabetics had stenosis of 50-70% (P = NS). Also type 2 DM patients had a higher number of coronary segments with mixed plaques compared to nondiabetic patients (1.67 +/- 2.01 vs. 1.23 +/- 1.61, P = 0.05), whereas no such differences were observed for non-calcified or calcified plaques. Nearly half (43%) of type 2 DM had coronary artery calcium scores (CACS) >or=400 vs. 29% in non diabetic patients (P = 0.03). Patients with type 2 DM tend to have atherosclerotic plaques which are more likely to be mixed in nature. Future studies need to elucidate the prognostic value of differences in plaque characteristics observed according to type 2 diabetic status.

Role of Coronary CT Angiography in Asymptomatic Patients With Type 2 Diabetes Mellitus

“…18) Meanwhile, the reported prevalence of significant stenosis in symptomatic nondiabetic patients ranges from 14 to 36%. 15,19,21) In our study, 30% of patients with asymptomatic diabetes had significant stenosis. This percentage is within the range of percentages reported for patients with symptoms.…”

“…Unlike the consensus opinion regarding high CAC scores in diabetes, these plaque characteristics differ widely from study to study. 15,16,19) In our opinion, the culprit responsible for the high incidence of coronary events among diabetic patients is vulnerable plaque, rather than calcification. Therefore, to prevent adverse consequences in these patients, we need an accurate way of identifying vulnerable plaque.…”

“…In this study, we focused on two features of coronary artery plaque, namely, positive remodeling and low attenuation. Although a number of previous studies have described coronary CT angiography of diabetic patients, [14][15][16][17][18][19][20][21][22] our study is the first to focus on these particular features of plaque.…”

“…The prevalence of significant stenosis of symptomatic patients and asymptomatic patients ranged from 33 to 42%, 15,19,21) and 15.2 to 29%, 16,20,22) respectively. A study containing both populations reported that the prevalence was 37%.…”

“…15,16,18) Furthermore, a high CAC score has a strong association with mortality. 23) We also confirmed an extremely high mean CAC score (486.2) in our study.…”