High-risk coronary artery plaque in asymptomatic patients with type 2 diabetes: clinical risk factors and coronary artery calcium score

Abstract

Background High-risk coronary artery plaque (HRP) is associated with increased risk of acute coronary syndrome. We aimed to investigate the prevalence of HRP in asymptomatic patients with type 2 diabetes (T2D), and its relation to patient characteristics including cardiovascular risk factors, diabetes profile, and coronary artery calcium score (CACS). Methods Asymptomatic patients with T2D and no previous coronary artery disease (CAD) were studied using coronary computed tomography angiography (CCTA) in this descriptive study. Plaques with two or more high-risk features (HRP) defined by low attenuation, positive remodeling, spotty calcification, and napkin-ring sign were considered HRP. In addition, total atheroma volume (TAV), proportions of dense calcium, fibrous, fibrous-fatty and necrotic core volumes were assessed. The CACS was obtained from non-enhanced images by the Agatston method. Cardiovascular and diabetic profiles were assessed in all patients. Results In 230 patients CCTA was diagnostic and 161 HRP were detected in 86 patients (37%). Male gender (OR 4.19, 95% CI 1.99–8.87; p < 0.01), tobacco exposure in pack years (OR 1.02, 95% CI 1.00–1.03; p = 0.03), and glycated hemoglobin (HbA1c) (OR 1.04, 95% CI 1.02–1.07; p < 0.01) were independent predictors of HRP. No relationship was found to other risk factors. HRP was not associated with increased CACS, and 13 (23%) patients with zero CACS had at least one HRP. Conclusion A high prevalence of HRP was detected in this population of asymptomatic T2D. The presence of HRP was associated with a particular patient profile, but was not ruled out by the absence of coronary artery calcium. CCTA provides important information on plaque morphology, which may be used to risk stratify this high-risk population. Trial registration This trial was retrospectively registered at clinical trials.gov January 11, 2017 trial identifier NCT03016910.

Microvascular Myocardial Ischemia in Patients With Diabetes Without Obstructive Coronary Stenosis and Its Association With Angina

“…Advanced coronary atherosclerosis is another hallmark of diabetes-related heart disease, and HRP is commonly encountered in asymptomatic patients with T2D [ 33 ]. The current study also investigated coronary anatomy and plaque characteristics in diabetes.…”

Biomarkers for Identification of High-Risk Coronary Artery Plaques in Patients with Suspected Coronary Artery Disease

“…Fourthly, assessment of plaque burden, stenosis, and HRPs is observer-dependent but the applied approach has been validated against intravascular ultrasound and has shown good inter- and intra-observer agreement and reproducibility. 17 , 34 , 35 Additionally, a blinded expert-reader reviewed all lesions with any risk feature to ensure consistency with the pre-defined criteria. Fifthly, we did not have the opportunity to investigate long term outcomes which could have demonstrated the stipulated risk of cardiovascular events for patients with HRPs and whether elevations in biomarkers independent of plaque risk features can predict cardiovascular events.…”

“…Significant diameter stenosis was defined as a ≥50% luminal diameter stenosis in any vessel segment with at diameter of >2mm at initial visual core lab evaluation. 17 Subsequently, qualitative HRP features were evaluated including 1) low-attenuation plaques towards lumen ≤30 Hounsfield units (HU), 2) positive remodeling index of >1.10 (determined by maximum lesion area/healthy reference vessel area), c) napkin ring sign (central low attenuation core, surrounded by a thin semi-circular plaque of lighter attenuation in the outer contour), and d) soft plaque with spotty calcifications encased in soft plaque (≤3mm length calcification). 18,19 A high-risk plaque (HRP) was defined as a plaque with at least two of the above features.…”

The Effect of Clinically Indicated Liraglutide on Pericoronary Adipose Tissue in Type 2 Diabetic Patients

“…Data for the current study was derived from a previous prospective observational single-center study performed at Odense University Hospital, Svendborg, Denmark, from March 2016 to September 2018 [32,33]. The primary aim of the original study was to investigate the changes in plaque burden and composition in T2DM.…”