Progression of coronary atherosclerotic plaque burden and relationship with adverse cardiovascular event in asymptomatic diabetic patients

Abstract

BackgroundThe heterogeneity of risk in patients with diabetes mellitus (DM) is acknowledged in new guidelines promulgating different treatment recommendations for diabetics at low cardiac risk. We performed a retrospective longitudinal follow-up study to evaluate coronary plaque progression and its impact on cardiac events in asymptomatic diabetic patients.MethodsData of 197 asymptomatic patients (63.1 ± 17 years, 60% males) with DM and suspected coronary artery disease (CAD) who underwent clinically indicated dual-source cardiac computed tomography (CT) were retrospectively analyzed. Patients with DM received standard of care treatment. Patients were classified into two groups based on CT coronary artery calcium scores (CACS): A, CACS> 10; B, CACS≤10. Progression of coronary plaque burden in both groups was evaluated and compared by baseline and follow-up coronary CT angiography (CCTA) using semi-automated plaque analysis and quantification software. Follow-up data were retrospectively gathered from medical records and endpoints of cardiac events were recorded via prospective phone-calls. The impacts of plaque composition and progression on cardiac events were specifically assessed.ResultsPatients with CACS> 10 showed an increase in dense coronary calcium volume, while patients with CACS≤10 had a more pronounced increase in the volume of low-attenuation “lipid-rich” plaque components between CCTA acquisitions. The composite endpoint occurred in 20 patients (10.2%) after a median follow-up period of 41.8 months. Furthermore, at follow-up CCTA, the presence of CACS> 10 (adjusted odds ratio, 0.701; 95% CI, 0.612–0.836), increase of dense calcium volume (OR, 0.860 95% CI, 0.771–0.960), and lipid volume (OR, 1.013; 95% CI, 1.007–1.020) were all independent predictors of cardiac events.ConclusionAsymptomatic patients with DM experienced plaque progression as well as progression to “overt or silent CAD”. The relative increase in plaque volume was associated with subsequent cardiac events, and the coronary calcification seemed to be inversely related to the outcome in asymptomatic diabetic patients.

Isolated downregulation of HCN2 in ventricles of rats with streptozotocin-induced diabetic cardiomyopathy

“…Although implying pro-arrhythmogenic potential, studies showed rather reduced risk of triggered ventricular dysrhythmias in STZ model [ 4 , 5 ]. This is in line with certain evidence showing less tendency of diabetic hearts to ventricular arrhythmias regardless of pronounced risk of cardiovascular morbidity and mortality in diabetic patients [ 4 , 6 , 34 ] but it is contradictory to the impaired cardiac repolarization in DM [ 2 , 35 ] suggesting effective compensatory mechanisms. The main finding of our study in this model is the downregulation of HCN2 channel exclusively in ventricular myocardium possibly contributing to regulation of electric stability of diabetic ventricles.…”

Quantitative assessment of coronary plaque volume change related to triglyceride glucose index: The Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging (PARADIGM) registry

“…To understand that the coronary atherosclerotic change is an important issue in clinical practice, it is well-known that diabetes has close association with the prevalence and severity of CCTA verified CAD progression [ 23 ]. Even asymptomatic diabetic patients experience plaque progression as well as evolution to overt or silent CAD, and an increase in the PV was reported to be associated with subsequent CV events [ 24 ]. In addition, the increased duration of diabetes combined with higher HbA1c levels deleteriously influences culprit-plaque characteristics among diabetic patients who suffered acute myocardial infarction [ 25 ].…”

“…Even asymptomatic diabetic patients experience plaque progression as well as evolution to overt or silent CAD, and an increase in the PV was reported to be associated with subsequent CV events [24]. In addition, the increased duration of diabetes combined with higher HbA1c levels deleteriously influences culprit-plaque characteristics among diabetic patients who suffered acute myocardial infarction [25].…”

Association of Cardiovascular Disease Risk Factor Burden With Progression of Coronary Atherosclerosis Assessed by Serial Coronary Computed Tomographic Angiography

“… 5 , 6 Serial assessment of coronary artery plaques through coronary CT angiography provides clinical information regarding the progression of disease and the risk of experiencing future adverse cardiovascular events. 7 , 8 …”