People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.

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BACKGROUND Coronary artery calcification is an established marker of risk of future cardiovascular events. Despite this, plaque calcification is also considered a marker of plaque stability, and increases in response to medical therapy. OBJECTIVESTo explore the impact of plaque calcification at a lesional and patient level on the natural history of coronary artery disease. METHODS This analysis included 925 patients with 2,568 lesions from the PARADIGM (Progression of atherosclerotic plaque determined by computed tomographic angiography imaging) registry, in which patients underwent serial coronary computed tomography angiography (CCTA).Plaque calcification was examined using calcified plaque volume (CPV) and percent calcified plaque volume (PCPV), calculated as (CPV/plaque volume (PV))*100. RESULTSCPV was strongly correlated with PV (r =0.780, p < 0.001) at baseline, and plaque progression (r=0.297, p < 0.001), however this association was reversed after accounting for plaque volume at baseline (r=-0.146, p < 0.001). In contrast PCPV was an independent predictor of a reduction in PV (r=-0.11, p<0.001) in univariable and multivariable linear regression analysis. Patient-level analysis showed that CPV showed an independent association with incident MACE (HR 3.01, 95% CI:1.58-5.72), whilst an increased PCPV was an independent predictor for MACE freesurvival (HR 0.529, 95% CI:0.229-0.968) in multivariable analysis. 4CONCLUSIONS Calcified plaque is a marker for risk of adverse event and disease progression due to its strong association with the total plaque burden. When considered as a percentage of the total plaque volume, increasing PCPV is a marker of plaque stability and reduced risk at both a lesion and patient level.