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

Laurits Juhl Heinsen, Gokulan Pararajasingam, Thomas Rueskov Andersen, Søren Auscher, Hussam Mahmoud Sheta, Helle Precht, Jess Lambrechtsen, Kenneth Egstrup, Laurits Juhl Heinsen, Gokulan Pararajasingam, Thomas Rueskov Andersen, Søren Auscher, Hussam Mahmoud Sheta, Helle Precht, Jess Lambrechtsen, Kenneth Egstrup

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.

Keywords: Asymptomatic coronary artery disease; Atherosclerosis; Coronary artery calcium score; Coronary computed tomography angiography; High-risk plaque; Type 2 diabetes.

Conflict of interest statement

The authors declare that no competing interests were present.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Plaque analysis with semiautomatic plaque analysis software. A Longitudinal straightened multiplanar reconstruction of left circumflex artery featuring a high-risk plaque (HRP) between the blue lines. B Transverse vessel view demonstrating HRP with positive remodeling, napkin ring sign, and low attenuation core (< 30 HU). C Graph depicting lumen and vessel areas as a function of vessel length. Plaque subtypes dense calcium, fibrous, fibrous-fatty and necrotic core are shown in grey, green, light green, and red colors. The bottom panels shows unenhanced axial images in the same patient demonstrating no coronary artery calcium present in the left main (LM) and left descending artery (LAD) (D), left circumflex artery (LCX) (E), and right coronary artery (RCA) (F, G)
Fig. 2
Fig. 2
Distribution of 230 patients with and without high-risk plaque (HRP) stratified by coronary artery calcium score (CACS)

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