Coronary Atherosclerotic Plaque Detected by Computed Tomographic Angiography in Subjects with Diabetes Compared to Those without Diabetes

Abstract

ObjectivesLittle data are available regarding coronary plaque composition and semi-quantitative scores in individuals with diabetes; the extent to which diabetes may affect the presence and extent of Coronary Artery Calcium (CAC) needs more evaluation. Considering that this information may be of great value in formulating preventive interventions in this population, we compared these findings in individuals with diabetes to those without.MethodsMulti-Detector Computed Tomographic (MDCT) images of 861 consecutive patients with diabetes who were referred to Los Angeles Biomedical Research Institute from January 2000 to September 2012, were evaluated using a 15–coronary segment model. All 861 patients underwent calcium scoring and from these; 389 had coronary CT angiography (CTA). CAC score was compared to 861 age, sex and ethnicity matched controls without diabetes after adjustment for Body Mass Index (BMI), family history of coronary artery disease, hyperlipidemia, hypertension and smoking. Segment Involvement Score (SIS; the total number of segments with any plaque), Segment Stenosis Score (SSS; the sum of maximal stenosis score per segment), Total Plaque Score (TPS; the sum of the plaque amount per segment) and plaque compositionwere compared to 389 age, sex and ethnicity matched controls without diabetes after adjustment for BMI, family history of coronary artery disease, hyperlipidemia, hypertension and smoking.ResultsDiabetes was positively correlated to the presence and extent of CAC (P<0.0001 for both). SIS, SSS and TPS were significantly higher in those with diabetes (P<0.0001). Number of mixed and calcified plaques were significantly higher in those with diabetes (P = 0.018 and P<0.001 respectively) but there was no significant difference in the number of non-calcified plaques between the two groups (P = 0.398).ConclusionsPatients with diabetes have higher CAC and semi-quantitative coronary plaque scores compared to the age, gender and ethnicity matched controls without diabetes after adjustment for cardiovascular risk factors. Since mixed plaque is associated with worse long-term clinical outcomes, these findings support more aggressive preventive measures in this population.

In Vivo and In Vitro Analysis in Coronary Artery Disease Related to Type 2 Diabetes

“…Total Agatston score was higher in diabetic patients (440 ± 786 vs 195 ± 404, P < 0.001) ( 5 ). Khazai et al found that segment involvement score, segment stenosis score, and total plaque score were higher in diabetics but there was no significant difference in the number of non-calcified plaque between the two groups ( 50 ). In one study by Pundziute et al, diabetics showed more diseased segments and more segments with non-obstructive CAD, but Agatston score was similar between the two groups ( 54 ).…”

Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus

“…30, 31 Progressive atherosclerotic lesions (i.e. pathological intimal thickening and early fibroatheroma) with micro-calcification cannot be identified by CT, 32 whereas late obstructive coronary artery disease is strongly associated with a high CAC score (Agatston score ≥400).…”

Alloxan-induced diabetes exacerbates coronary atherosclerosis and calcification in Ossabaw miniature swine with metabolic syndrome

“…While IVUS is a robust method for determining plaque morphology in vivo, it cannot determine plaque composition with chemical specificity. This is of particular interest, as diabetes is associated with lipid laden plaques that are more vulnerable to rupture [ 50 ]. Intravascular photoacoustic ultrasound includes morphological imaging and has chemical specificity to determine lipid content inside atherosclerotic plaque [ 51 – 54 ].…”