Computed Tomography Angiography Images of Coronary Artery Stenosis Provide a Better Prediction of Risk Than Traditional Risk Factors in Asymptomatic Individuals With Type 2 Diabetes: A Long-term Study of Clinical Outcomes

Lee, Kwan Yong; Hwang, Byung‐Hee; Kim, Tae-Hoon; Kim, Chan Jun; Kim, Jin‐Jin; Choo, Eun Ho; Choi, Ik Jun; Choi, Young; Park, Ha-Wook; Koh, Yoon Seok; Kim, Pum-Joon; Lee, Jong Min; Kim, Mi-Jeong; Jeon, Doo Soo; Cho, Jae‐Hyoung; Jung, Jung Im; Seung, Ki‐Bae; Chang, Kiyuk

doi:10.2337/dc16-1844

Cited by 31 publications

(33 citation statements)

References 34 publications

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“…CT angiography images of coronary artery stenosis provide a better prediction risk in asymptomatic type 2 diabetics than traditional risk factors and the CACs 38 39. Notably, we have found for the first time a relationship between DR and the presence of coronary stenosis assessed by coronary CT angiography.…”

Section: Discussionmentioning

confidence: 64%

Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study

Simó

Bañeras

Hernández

et al. 2019

BMJ Open Diab Res Care

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ObjectiveDetection of subclinical cardiovascular disease (CVD) has significant impact on the management of type 2 diabetes. We examined whether the assessment of diabetic retinopathy (DR) is useful for identifying patients at a higher risk of having silent CVD.Research design and methodsProspective case–control study comprising 200 type 2 diabetic subjects without history of clinical CVD and 60 age-matched non-diabetic subjects. The presence of subclinical CVD was examined using two parameters: (1) calcium coronary score (CACs); (2) composite of CACs >400 UA, carotid plaque ≥3 mm, carotid intima–media thickness ratio >1, or the presence of ECG changes suggestive of previous asymptomatic myocardial infarction. In addition, coronary angio-CT was performed. DR was assessed by slit-lamp biomicroscopy and retinography.ResultsType 2 diabetic subjects presented higher CACs than non-diabetic control subjects (p<0.01). Age, male gender, and the presence of DR were independently related to CACs >400 (area under the receiver operating characteristic curve (AUROC) 0.76). In addition, an inverse relationship was observed between the degree of DR and CACs <10 AU. The variables independently associated with the composite measurement of subclinical CVD were age, diabetes duration, the glomerular filtration rate, microalbuminuria, and the presence of DR (AUROC 0.71). In addition, a relationship (p<0.01) was observed between the presence and degree of DR and coronary stenosis.ConclusionsThe presence and degree of DR is independently associated with subclinical CVD in type 2 diabetic patients. Our results lead us to propose a rationalized screening for coronary artery disease in type 2 diabetes based on prioritizing patients with DR, particularly those with moderate–severe degree.

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Section: Discussionmentioning

confidence: 64%

Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study

Simó

Bañeras

Hernández

et al. 2019

BMJ Open Diab Res Care

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“…The diagnosis of T2DM was based on the American Diabetes Association 2014 criteria: fasting plasma glucose (FPG) ≥ 7.0 mmol/L and/or HbA1c ≥ 6.5% and/ or 2-h post-challenge plasma glucose ≥ 11.1 mmol/L and/ or ongoing therapy for T2DM [20]. Obstructive CAD was defined as the maximum luminal stenosis of ≥ 50% in any segment of major coronary arteries [21,22].…”

Section: Study Populationmentioning

confidence: 99%

“…We defined vessel distribution by the left anterior descending artery and its branches, the left circumflex artery and its branches, and the right coronary artery and its branches. Patients with ≥ 50% stenosis of left main coronary artery were classified into the 3-vessel obstructive CAD group [22]. So we finally created four categories of CAD extent: non-obstructive CAD, 1-, 2-, 3-vessel/left main obstructive CAD.…”

Section: Study Populationmentioning

confidence: 99%

Mitochondrial 8-hydroxy-2′-deoxyguanosine and coronary artery disease in patients with type 2 diabetes mellitus

Wang

Cui

Liu

et al. 2020

Cardiovasc Diabetol

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Background: Little is known about whether mitochondria 8-hydroxy-2′-deoxyguanosine (8-OHdG), a biomarker of mitochondrial DNA (mtDNA) oxidative damage, contributes to the development of coronary artery disease (CAD) in diabetic patients. Here, we explored the associations of mtDNA 8-OHdG in leukocytes with obstructive CAD, coronary stenosis severity, cardiovascular biomarkers, and 1-year adverse outcomes after coronary revascularization in patients with type 2 diabetes mellitus (T2DM). Methods: In a total of 1920 consecutive patients with T2DM who underwent coronary angiography due to symptoms of angina or angina equivalents, the presence of obstructive CAD, the number of diseased vessels with ≥ 50% stenosis, and modified Gensini score were cross-sectionally evaluated; the level of mtDNA 8-OHdG was quantified by quantitative PCR. Then, 701 of 1920 diabetic patients who further received coronary revascularization completed 1-year prospective follow-up to document major adverse cardiovascular and cerebral events (MACCEs). In vitro experiments were also performed to observe the effects of mtDNA oxidative damage in high glucose-cultured human umbilical vein endothelial cells (HUVECs). Results: Cross-sectionally, greater mtDNA 8-OHdG was associated with increased odds of obstructive CAD (odds ratio [OR] 1.38, 95% CI confidence interval 1.24-1.52), higher degree of coronary stenosis (number of diseased vessels: OR 1.29, 95% CI 1.19-1.41; modified Gensini scores: OR 1.28, 95% CI 1.18-1.39), and higher levels of C-reactive protein (β 0.18, 95% CI 0.06-0.31) after adjusting for confounders. Sensitivity analyses using propensity score matching yielded similar results. Stratification by smoking status showed that the association between mtDNA 8-OHdG and obstructive CAD was most evident in current smokers (P interation < 0.01). Prospectively, the adjusted hazards ratio per 1-SD increase in mtDNA 8-OHdG was 1.59 (95% CI 1.33-1.90) for predicting 1-year MACCEs after revascularization. In HUVECs, exposure to antimycin A, an inducer for mtDNA oxidative damage, led to adverse alterations in markers of mitochondrial and endothelia function. Conclusion: Greater mtDNA 8-OHdG in leukocytes may serve as an independent risk factor for CAD in patients with T2DM.

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“…Furthermore, all study subjects were enrolled at our healthcare center, not cardiovascular clinic, were not diagnosed with diabetes, did not have a prior history of CAD, and the coronary atherosclerosis was not severe. Therefore, we used SIS (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16) to represent the degree of coronary plaque involvement, and not SSS (1-48), because few subjects had a high SSS. Actually, strong correlations were observed between the SSS, SIS, ABOS and calcium scores ( Supplementary Table 3).…”

Section: Discussionmentioning

confidence: 99%

Hemoglobin A1C Levels are Independently Associated with the Risk of Coronary Atherosclerotic Plaques in Patients without Diabetes: A Cross-Sectional Study

Wang

Hsu

Lin

et al. 2020

JAT

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The official journal of the Japan Atherosclerosis Society and the Asian Pacific Society of Atherosclerosis and Vascular Diseases Original Article Aim: Coronary atherosclerotic plaques can be detected in asymptomatic subjects and are related to low-density lipoprotein cholesterol (LDL) levels in patients with coronary artery disease. However, researchers have not yet determined the associations between various plaque characteristics and other lipid parameters, such as HDL-C and TG levels, in low-risk populations. Methods: One thousand sixty-four non-diabetic subjects (age, 57.86 9.73 years; 752 males) who underwent coronary computed tomography angiography (CCTA) were enrolled and the severity and patterns of atherosclerotic plaques were analyzed. Results: Statin use was reported by 25% of the study population, and subjects with greater coronary plaque involvement (segment involvement score, SIS) were older and had a higher body mass index (BMI), blood pressure, unfavorable lipid profiles and comorbidities. After adjusting for comorbidities, only age (0.085, p 0.001), the male gender (1.384, p 0.001), BMI (0.055, p 0.019) and HbA1C levels (0.894, p 0.001) were independent factors predicting the greater coronary plaque involvement in non-diabetic subjects. In the analysis of significantly different (50%) stenosis plaque patterns, age (OR: 1.082, 95% CI: 10.47-1.118) and a former smoking status (OR: 2.061, 95% CI: 1.013-4.193) were independently associated with calcified plaques. For partial calcified (mixed type) plaques, only age (OR: 1.085, 95% CI: 1.052-1.119), the male gender (OR: 7.082, 95% CI: 2.638-19.018), HbA1C levels (OR: 2.074, 95% CI: 1.036-4.151), and current smoking status (OR: 1.848, 95% CI: 1.089-3.138) were independently associated with the risk of the presence of significant stenosis in mixed plaques. Conclusions: A higher HbA1c levels is independently associated with the presence and severity of coronary artery atherosclerosis in non-diabetic subjects, even when LDL-C levels are tightly controlled. causes of an increased risk in mortality and morbidity, and the central component of the pathogenesis is atherosclerosis. Atherosclerosis is currently considered a

show abstract

Computed Tomography Angiography Images of Coronary Artery Stenosis Provide a Better Prediction of Risk Than Traditional Risk Factors in Asymptomatic Individuals With Type 2 Diabetes: A Long-term Study of Clinical Outcomes

Abstract: Based on our data, the addition of CCTA-detected obstructive CAD to models that include traditional risk factors improves the predictions of MACE in asymptomatic patients with type 2 diabetes.

Cited by 31 publications

References 34 publications

Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study

Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study

Mitochondrial 8-hydroxy-2′-deoxyguanosine and coronary artery disease in patients with type 2 diabetes mellitus

Hemoglobin A1C Levels are Independently Associated with the Risk of Coronary Atherosclerotic Plaques in Patients without Diabetes: A Cross-Sectional Study

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