Differences in Atherosclerotic Plaque Burden and Morphology Between Type 1 and 2 Diabetes as Assessed by Multislice Computed Tomography

Abstract

OBJECTIVEIt is unclear whether the coronary atherosclerotic plaque burden is similar in patients with type 1 and type 2 diabetes. By using multislice computed tomography (MSCT), the presence, degree, and morphology of coronary artery disease (CAD) in patients with type 1 and type 2 diabetes were compared.RESEARCH DESIGN AND METHODSProspectively, coronary artery calcium (CAC) scoring and MSCT coronary angiography were performed in 135 asymptomatic patients (65 patients with type 1 diabetes and 70 patients with type 2 diabetes). The presence and extent of coronary atherosclerosis as well as plaque phenotype were assessed and compared between groups.RESULTSNo difference was observed in average CAC score (217 ± 530 vs. 174 ± 361) or in the prevalence of coronary atherosclerosis (65% vs. 71%) in patients with type 1 and type 2 diabetes. However, the prevalence of obstructive atherosclerosis was higher in patients with type 2 diabetes (n = 24; 34%) compared with that in patients with type 1 diabetes (n = 11; 17%) (P = 0.02). In addition, a higher mean number of atherosclerotic and obstructive plaques was observed in patients with type 2 diabetes. In addition, the percentage of noncalcified plaques was higher in patients with type 2 (66%) versus type 1 diabetes (27%) (P < 0.001), resulting in a higher plaque burden for each CAC score compared with that in type 1 diabetic patients.CONCLUSIONSAlthough CAC scores and the prevalence of coronary atherosclerosis were similar between patients with type 1 and type 2 diabetes, CAD was more extensive in the latter. Also, a relatively higher proportion of noncalcified plaques was observed in patients with type 2 diabetes. These observations may be valuable in the development of targeted management strategies adapted to diabetes type.

Low Prevalence of Subclinical Atherosclerosis in Asymptomatic Patients With Type 1 Diabetes in a European Mediterranean Population

“…Few studies on CACS measurement in the asymptomatic type 1 diabetic population have been performed (15,16,(23)(24)(25). Data concerning the Mediterranean population are even scarcer and our results clearly differ from previously published reports that showed higher CACS in comparison with our findings (see Table 3).…”

Gender differences in sclerostin and clinical characteristics in type 1 diabetes mellitus

“…These phenotypic changes permit arterial VSMC migration into the intima where these cells are able to express several osteogenic genes such as the osteoblastic transcription factor, Cbfa1/Runx2, bone morphogenetic protein 2 (BMP2), and Msx2 (a promoter of early osteoblast development) in addition to extracellular matrix and matrix-degrading metalloproteinases (12,13,37). The prevalence of coronary atherosclerosis is similar between patients with T1DM and those with T2DM, with a relatively higher proportion of noncalcified plaques observed in patients with T2DM in comparison with those with T1DM (38). As T2DM was reported previously to show higher sclerostin levels than T1DM (16), it is reasonable to speculate that sclerostin could act as an inhibitor of VC in T2DM.…”

“…A reduced bone formation as a consequence of reduced osteoblast activity has been identified as the mean pathogenetic effect or for low bone mineral density (BMD) in subjects with T1DM (1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39). intimal thickening in atherosclerosis, and Wnt/b-catenin signaling is a regulator of VSMC behavior (9).…”

Coronary Computed Tomographic Angiography and Risk of All-Cause Mortality and Nonfatal Myocardial Infarction in Subjects Without Chest Pain Syndrome From the CONFIRM Registry (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry)

“…23 Although not recommended by current guidelines, 21,29 a few early reports have emerged evaluating the use of cCTA for risk stratification in asymptomatic high-risk individuals. [13][14][15][16][17] However, the prognostic implication of occult CAD was not addressed adequately because of a very low rate of hard events (death or nonfatal MI). 33 In addition, the value of cCTA to predict mortality could not be evaluated because of small study samples, and evaluation of cCTA compared with CACS for the prediction of cardiac events was not performed.…”

“…However, in these groups without chest pain syndrome, limited data exist to substantiate the prognostic value and clinical usefulness of cCTA over traditional strategies of CAD evaluation. [13][14][15][16][17] We therefore evaluated in a large international multicenter registry whether CAD assessment by cCTA improved the stratification of risk in individuals without chest pain syndrome, and we examined the incremental value of cCTA findings to clinical risk factor scoring and CACS.…”