Asymptomatic coronary artery disease in a Norwegian cohort with type 2 diabetes: a prospective angiographic study with intravascular ultrasound evaluation

Abstract

Aims The prevalence of asymptomatic coronary artery disease (CAD) in type 2 diabetes (T2D) is unclear. We investigated the extent and prevalence of asymptomatic CAD in T2D patients by utilizing invasive coronary angiography (ICA) and intravascular ultrasound (IVUS), and whether CAD progression, evaluated by ICA, could be modulated with a multi-intervention to reduce cardiovascular (CV) risk. Methods Fifty-six T2D patients with ≥ 1 additional CV risk factor participated in a 2 year randomized controlled study comparing hospital-based multi-intervention (multi, n = 30) versus standard care (stand, n = 26), with a pre-planned follow-up at year seven. They underwent ICA at baseline and both ICA and IVUS at year seven. ICA was described by conventional CAD severity and extent scores. IVUS was described by maximal intimal thickness (MIT), percent and total atheroma volume and compared with individuals without T2D and CAD (heart transplant donors who had IVUS performed 7–11 weeks post-transplant, n = 147). Results Despite CV risk reduction in multi after 2 years intervention, there was no between-group difference in the progression of CAD at year seven. Overall, the prevalence of CAD defined by MIT ≥ 0.5 mm in the T2DM subjects was 84%, and as compared to the non-T2DM controls there was a significantly higher atheroma burden (mean MIT, PAV and TAV in the T2D population were 0.75 ± 0.27 mm, 33.8 ± 9.8% and 277.0 ± 137.3 mm 3 as compared to 0.41 ± 0.19 mm, 17.8 ± 7.3% and 134.9 ± 100.6 mm 3 in the reference population). Conclusion We demonstrated that a 2 year multi-intervention, despite improvement in CV risk factors, did not influence angiographic progression of CAD. Further, IVUS revealed that the prevalence of asymptomatic CAD in T2D patients is high, suggesting a need for a broader residual CV risk management using alternative approaches. Trial registration Clinical trials.gov id: NCT00133718 ( https://clinicaltrials.gov/ct2/show/NCT00133718 ) Electronic supplementary material The online version of this article (10.1186/s12933-019-0832-2) contains supplementary material, which is available to authorized users.

Circulating retinol binding protein 4 levels in coronary artery disease: a systematic review and meta-analysis

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The effect of preventative cardiovascular therapies on coronary artery disease in people with and without type 2 diabetes: a propensity-matched score study

“…It is possible that the initial increase in severity of CAD burden seen in our study for patients with T2DM may represent improved CAD screening over recent years rather than suboptimal application of preventative therapies to slow disease progression within the coronary arteries. A lower threshold for performing a coronary angiogram may also exist for patients with T2DM given the appreciated higher risk of CAD a diagnosis of T2DM confers and a higher appreciation of asymptomatic CAD in patients with T2DM [ 25 ]. Possibly, wider use of medications such as SGLT-2 inhibitors and GLP-1 receptor agonists which have been shown to have CV protective effects will result in improvements in CAD burden following 2019 for patients with diabetes, however a longer duration of follow-up will be required to confirm whether the attenuation of severity in CAD is a true finding [ 26 – 29 ].…”

Macrophage accumulation within coronary arterial wall in diabetic patients with acute coronary syndrome: a study with in-vivo intravascular imaging modalities

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