Impact of Diabetes Control on Subclinical Atherosclerosis: Analysis from Coronary Computed Tomographic Angiography Registry

• Published in: Diabetes & metabolism journal Vol. 44; no. 3; pp. 470 - 479
• Main Authors: Park, Gyung-Min, Lee, Chang Hoon, Lee, Seung-Whan, Yun, Sung-Cheol, Kim, Young-Hak, Kim, Yong-Giun, Won, Ki-Bum, Ann, Soe Hee, Kim, Shin-Jae, Yang, Dong Hyun, Kang, Joon-Won, Lim, Tae-Hwan, Koh, Eun Hee, Lee, Woo Je, Kim, Min-Seon, Park, Joong-Yeol, Kim, Hong-Kyu, Choe, Jaewon, Lee, Sang-Gon
• Format: Journal Article
• Language: English
• Published: Korean Diabetes Association 01.06.2020; 대한당뇨병학회
• Subjects: atherosclerosis; coronary artery disease; diabetes complications; diabetes mellitus; Original; 내과학
• ISSN: 2233-6079; 2233-6087
• DOI: 10.4093/dmj.2019.0073

BACKGROUNDThere are limited data on the impact of diabetes control on the risk of subclinical coronary atherosclerosis. METHODSWe analyzed 6,434 consecutive asymptomatic individuals without previous history of coronary artery disease who underwent coronary computed tomographic angiography (CCTA) (mean age, 53.7±7.6 years and 4,694 men [73.0%]). The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA, and ≥50% diameter stenosis was defined as significant. A cardiac event was defined as a composite of all-cause death, myocardial infarction, unstable angina, or coronary revascularization. Study participants were categorized as normal (n=5,319), controlled diabetes (glycosylated hemoglobin [HbA1c] <7%, n=747), or uncontrolled diabetes (HbA1c ≥7%, n=368), respectively. RESULTSCompared with normal individuals, there were no statistically significant differences in the risk of for any atherosclerotic plaque (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.98 to 1.38; P=0.086) and significant coronary artery stenosis (OR, 1.08; 95% CI, 0.82 to 1.42; P=0.583) in controlled diabetic individuals. In contrast, uncontrolled diabetic individuals had consistently higher risks of any atherosclerotic plaque (OR, 2.16; 95% CI, 1.70 to 2.75; P<0.001) and significant coronary artery stenosis (OR, 3.34; 95% CI, 2.52 to 4.43; P<0.001) than normal individuals. During a follow-up of median 5.4 years, there was no significant difference in cardiac events between normal and controlled diabetic individuals (P=0.365). However, uncontrolled diabetes was associated with an increased risk of cardiac events compared with normal individuals (P<0.001) and controlled diabetic individuals (P=0.023). CONCLUSIONAsymptomatic uncontrolled diabetes was associated with significant subclinical coronary atherosclerosis with subsequent high risk for cardiac events.