Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study

Shreenidhi M Venuraju, Avijit Lahiri, Anand Jeevarethinam, Mark Cohen, Daniel Darko, Devaki Nair, Miranda Rosenthal, Roby D Rakhit, Shreenidhi M Venuraju, Avijit Lahiri, Anand Jeevarethinam, Mark Cohen, Daniel Darko, Devaki Nair, Miranda Rosenthal, Roby D Rakhit

Abstract

Background: Evidence from imaging studies suggests a high prevalence of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, there are no criteria for initiating screening for CAD in this population. The current study investigated whether clinical and demographic characteristics can be used to predict significant CAD in patients with T2DM.

Methods: Computed tomography coronary angiography (CTCA) and laboratory assessments were performed in 259 patients diagnosed with T2DM attending clinics in Northwest London, UK. Coronary artery calcium (CAC) was calculated during CTCA. Significant plaque was defined as one causing more than 50% luminal stenosis. Associations between groups and variables were evaluated using Student's t test, Chi-square tests and univariate and multivariate regression analysis. P < 0.05 was considered statistically significant.

Results: Among patients with a median duration of T2DM of 13 years and a mean age of 62.0 years, median CAC score was 105.91 Agatston Units. In a multivariate analyses, duration of diabetes, CAC score and the presence and number of coronary artery plaques and presence of significant plaque were significant predictors of cardiovascular adverse events. Systolic blood pressure (SBP) had borderline significance as a predictor of cardiovascular events (p = 0.05). In a receiver operating characteristic curve (ROC) analysis, duration of diabetes of > 10.5 years predicted significant CAD (sensitivity, 75.3%; specificity 48.2%). Area under the ROC curve was 0.67 when combining duration of T2DM > 10.5 years and SBP of > 139 mm Hg. Adverse cardiovascular events after a median follow-up of 22.8 months were also significantly higher in those with duration of T2DM > 10.5 years and SBP > 140 mm Hg (log rank p = 0.02 and 0.009, respectively).

Conclusions: Routine screening for CAD using CTCA should be considered for patients with a diagnosis of T2DM for > 10.5 years and SBP > 140 mm Hg. Trial registration Clinicaltrials.gov identifier: NCT02109835, 10 April 2014 (retrospectively registered).

Keywords: Atherosclerosis; Computed tomography coronary angiography; Coronary artery calcium; Risk stratification; Silent coronary artery disease; Type 2 diabetes mellitus.

Conflict of interest statement

The authors have no financial or non-financial competing interests to declare.

Figures

Fig. 1
Fig. 1
Adverse CV events survival probability by a duration of T2DM, b SBP, and c combined score. Kaplan–Meier adverse CV event survival analysis during the follow-up period (median follow-up: 22.8 months). Cumulative score (ranging from 0 to 2) was based on duration of diabetes > 10.5 years and systolic blood pressure of 140 mm Hg. CV, cardiovascular; SBP, systolic blood pressure

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