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Relationship between glycemic control and coronary artery disease severity, prevalence and plaque characteristics by computed tomography coronary angiography in asymptomatic type 2 diabetic patients

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Abstract

Evaluate whether glycemic control in type 2 diabetes (DM2) asymptomatic for coronary artery disease (CAD) affects not only the presence and magnitude of CAD but also the characteristics of plaque vulnerability using multidetector row computed coronary tomography (MDCT). Acute coronary syndrome (ACS) is frequently observed in asymptomatic DM2 patients. Positive vessel remodeling (PR) and low-attenuation plaques (LAP) identified by MDCT have been demonstrated to be characteristics of subsequent culprit lesions of ACS. However, little is known regarding plaque characteristics in asymptomatic diabetic patients and their relationship with glycemic control. Ninety asymptomatic DM2 patients, aged 40–65 years old, underwent MDCT. The presence of atherosclerotic obstruction, defined as coronary stenosis ≥50 %, and plaque characteristics were compared between two groups of patients with A1c < 7 and A1c ≥ 7 %. Of the 90 patients, 38 (42.2 %) presented with coronary atherosclerotic plaques, 11 had A1c < 7 % and 27 had A1c ≥ 7 % (p = 0.0006). Fourteen patients had significant lumen obstruction higher than 50 %: 3 in the A1c < 7 % group and 11 in the A1c ≥ 7 % group (p = 0.02). Non-calcified plaque was more prevalent in the A1c ≥ 7 % group (p = 0.005). In eleven patients, the simultaneous presence of two vulnerability plaque characteristics (PR and LAP) were observed more frequently in the A1c ≥ 7 group (n = 8) than in the A1c < 7 group (n = 3) (p = 0.04). Asymptomatic DM2 patients with A1c ≥ 7 % have a higher frequency of CAD and a higher proportion of vulnerable atherosclerotic coronary plaque by MDCT compared to patients with DM2 with A1c < 7 in our study.

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Abbreviations

DM2:

Type 2 diabetes mellitus

CAD:

Coronary artery disease

MDCT:

Multidetector row computed coronary tomography

LAP:

Low-attenuation atherosclerotic plaque

PR:

Positive vessel remodeling

IVUS:

Intravascular ultrasound

ACS:

Acute coronary syndrome

BMI:

Body mass index

CACS:

Coronary artery calcium score

HR:

Heart rate

CTA:

Computed tomography angiography

Bpm:

Beats per minute

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Acknowledgments

This work was financial supported by Research Center—FAPESP—Fundação de Amparo à Pesquisa do Estado de São Paulo, São Paulo, SP, Brasil; Process: 10/51705-6.

Author contributions

Tavares CAF, Rassi CHRE, Fahel MG, Wajchenberg BL, Rochitte CE and Lerario AC, contributed to the design, analyses, data collection, and writing of the manuscript.

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Authors and Affiliations

  1. Diabetes Group of the Heart Institute (Instituto do Coração -InCor) and Endocrinology Course (LIM 25), Clinics Hospital of the Medical School, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar 44, andar AB, Núcleo de diabetes e doença, Cardiovascular, Cerqueira César, São Paulo, SP, 05403-000, Brazil

    C. A. F. Tavares, B. L. Wajchenberg & A. C. Lerario

  2. Department of Radiology, Heart Institute (Instituto do Coração -InCor) of the Medical School, University of São Paulo, São Paulo, SP, Brazil

    C. H. R. E. Rassi, M. G. Fahel & C. E. Rochitte

Authors
  1. C. A. F. Tavares
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  2. C. H. R. E. Rassi
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  3. M. G. Fahel
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  4. B. L. Wajchenberg
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  5. C. E. Rochitte
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  6. A. C. Lerario
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Correspondence to C. A. F. Tavares.

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Tavares, C.A.F., Rassi, C.H.R.E., Fahel, M.G. et al. Relationship between glycemic control and coronary artery disease severity, prevalence and plaque characteristics by computed tomography coronary angiography in asymptomatic type 2 diabetic patients. Int J Cardiovasc Imaging 32, 1577–1585 (2016). https://doi.org/10.1007/s10554-016-0942-9

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  • DOI: https://doi.org/10.1007/s10554-016-0942-9

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