Effect of Smoking on Coronary Artery Plaques in Type 2 Diabetes Mellitus: Evaluation With Coronary Computed Tomography Angiography

• Published in: Frontiers in endocrinology (Lausanne) Vol. 12; p. 750773
• Main Authors: Jiang, Yu, Pang, Tong, Shi, Rui, Qian, Wen-Lei, Yan, Wei-Feng, Li, Yuan, Yang, Zhi-Gang
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 03.11.2021
• Subjects: Aged; Aged, 80 and over; atherosclerosis; Computed Tomography Angiography; Constriction, Pathologic; Coronary Artery Disease - diagnostic imaging; coronary artery plaques; coronary computed tomographic angiography; Coronary Vessels - diagnostic imaging; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - pathology; Endocrinology; Female; Humans; Male; Middle Aged; Plaque, Atherosclerotic - diagnostic imaging; Predictive Value of Tests; Retrospective Studies; smoking; Tobacco Smoking - adverse effects; Tomography, X-Ray Computed; type 2 diabetes mellitus; atherosclerosis; type 2 diabetes mellitus; coronary computed tomographic angiography; coronary artery plaques; smoking
• ISSN: 1664-2392; 1664-2392
• DOI: 10.3389/fendo.2021.750773

The effect of smoking on coronary artery plaques examined by coronary computed tomography angiography (CCTA) in type 2 diabetes mellitus (DM) patients is not fully understood. This study explored the effect of smoking on coronary artery plaques by comparing the characteristics of plaques between diabetes patients with and without a smoking history and among those with different smoking durations. In total, 1058 DM patients found to have coronary plaques on CCTA were categorized into the smoker (n=448) and nonsmoker groups (n=610). Smokers were stratified by smoking duration [≤20 years (n=115), 20~40 years (n=233) and >40 years (n=100)]. The plaque types, luminal stenosis [obstructive (<50%) or nonobstructive (≥50%) stenosis], segment involvement score (SIS), and segment stenosis score (SSS) of the CCTA data were compared among groups. Compared to nonsmokers, smokers demonstrated increased odds ratios (ORs) of any noncalcified plaques (OR=1.423; P=0.014), obstructive plaques (OR=1.884; P<0.001), multivessel disease (OR=1.491; P=0.020), SIS≥4 (OR=1.662; P<0.001), and SSS≥7 (OR=1.562; P=0.001). Compared to diabetes patients with a smoking duration ≤20 years, those with a smoking duration of 20~40 years and >40 years had higher OR of any mixed plaques (OR=2.623 and 3.052, respectively; Ps<0.001), obstructive plaques (OR=2.004 and 2.098; P=0.003 and 0.008, respectively), multivessel disease (OR=3.171 and 3.784; P<0.001 and P=0.001, respectively), and SSS≥7 (OR=1.605 and 1.950; P=0.044 and 0.020, respectively). Diabetes with a smoking duration >40 years had a higher OR of SIS≥4 (OR=1.916, P=0.034). Smoking is independently associated with the presence of noncalcified, obstructive, and more extensive coronary artery plaques in diabetes patients, and a longer smoking duration is significantly associated with a higher risk of mixed, obstructive, and more extensive plaques.