The effect of LDL-C status on the association between increased coronary artery calcium score and compositional plaque volume progression in statins-treated diabetic patients: evaluated using serial coronary CTAs

Abstract

Background In statins-treated diabetic mellitus (DM) patients, longitudinal coronary CTA (CCTA) evidence is scarce regarding the relationship between coronary Agatston artery calcification scores (CACs) and coronary plaque progression. This study was designed to investigate whether the association between CACs progression and compositional plaque volumes (PVs) progression differed between follow-up low-density lipoprotein cholesterol (LDL-C) controlled and uncontrolled groups in statins-treated DM patients. Methods From January 2015 to June 2021, 208 patients who submitted serial clinically indicated CCTAs in our hospital were included in this study. Participants were further subdivided into LDL-C controlled (n = 75) and LDL-C uncontrolled (n = 133) groups according to whether the LDL-C reached the treatment goals at follow-up. Baseline and follow-up CCTA image datasets were quantified analysis at per-patient and per-plaque levels. The annual change of total PV (TPV), calcific PV(CPV), non-calcific PV (NCPV), low-density non-calcific PV (LD-NCPV), and CACs were assessed and further compared according to follow-up LDL-C status. The effect of CACs progression on the annual change of componential PVs was evaluated according to follow-up LDL-C status at both per-patient and per-plaque levels. Results The annual change of CACs was positively associated with the annual change of TPV (β = 0.43 and 0.61, both p < 0.001), CPV (β = 0.23 and β = 0.19, p < 0.001 and p = 0.004, respectively), NCPV (β = 0.20 and β = 0.42, p < 0.001 and p = 0.006, respectively), and LD-NCPV (β = 0.08 and 0.13, p < 0.001 and p = 0.001, respectively) both on per-patients and per-plaque levels. LDL-C status had no effect on the annual change of TPV, CPV, NCPV, and LD-NCPV (all p > 0.05). After adjusting for confounding factors, on the per-patient level, the increase in CACs was independently associated with annual change of TPV (β = 0.650 and 0.378, respectively, both p < 0.001), CPV (β = 0.169 and 0.232, respectively, p = 0.007 and p < 0.001), NCPV (β = 0.469 and 0.144, respectively, both p = 0.001), and LD-NCPV (β = 0.082 and 0.086, respectively, p = 0.004 and p = 0.006) in LDL-C controlled and LDL-C uncontrolled group. On the per-plaque level, the increase in CACs was independently associated with the annual change of NCPV and LD-NCPV in LDL-C uncontrolled patient (β = 0.188 and 0.106, p < 0.001), but not in LDL-C controlled group (β = 0.268 and 0.056, p = 0.085 and 0.08). Conclusions The increase of CACs in statins-treated DM patients indicates the progression of compositional PVs. From a per-plaque perspective, there might be increased instability of individual plaques concomitant with CACs increase in LDL-C uncontrolled patients.

Deep learning-based coronary artery calcium score to predict coronary artery disease in type 2 diabetes mellitus

“…The increasing numbers of type 2 diabetes mellitus (T2DM), is a leading cause of disability and mortality, which poses focus on heightened coronary artery disease (CAD) [ 1 ]. Comorbidities of hyperglycemia, insulin resistance and hyperlipidemia in T2DM, have synergistically promoted the development and progression of CAD [ 2 ], and therefore patients with T2DM have higher incidence of CAD compared with the nondiabetic population [ 3 ]. Increase advanced glycation end products (AGEs) increase oxidative stress and activate intracellular signal, which contribute to vascular inflammation, endothelial disfunction injury, vascular smooth muscle cells proliferation and platelet activity [ 4 ].…”

Unsupervised machine learning based on clinical factors for the detection of coronary artery atherosclerosis in type 2 diabetes mellitus

“…T2DM is often accompanied by other risk factors [1,9]. Although the risk factors for cardiovascular disease have been elucidated separately [10][11][12], the different clinical features of T2DM patients have varying influences on coronary atherosclerosis [13][14][15]. The comprehensive effect of the clinical features of T2DM on coronary atherosclerosis still needs further study.…”

Ethnicity should be included as a risk factor for coronary artery calcium score

“…We read with great interest the article by Shi et al [ 1 ] as this paper investigated the association between LDL-C status and coronary artery calcium score (CACs) in statin-treated diabetic patients. This study absolutely contributes to the current literature on diabetic population and cardiovascular risk assessment.…”