Abstract 16418: The Impact of Glucose Control on High-Risk Coronary Plaque Compositions Assessed by Coronary CT Angiography in Patients With Type 2 Diabetes Mellitus
Background: Although type 2 diabetes mellitus (DM) is a risk factor for coronary artery disease (CAD), the influence of glycemic control on coronary plaque compositions in type 2 DM patients has not been well investigated in a noninvasive way. Low attenuation plaque, positive remodeling, and spotty calcification assessed by coronary CT angiography (CCTA) have been reported to be related to adverse outcomes. The purpose of this study was to evaluate the impact of glucose control on high-risk coronary plaque compositions assessed by CCTA in patients with type 2 DM.
Methods: A total of 217 consecutive patients with type 2 DM (142 males, 65±10 years) underwent 64-slice CCTA and 2820 coronary segments were analyzed. Enrolled patients had an intermediate to high pre-test probability of obstructive CAD in clinical practice. We classified the patients according to HbA1c level; 86 patients with HbA1c value <6.5% (lower group), 131 patients with HbA1c value ≥6.5% (higher group). We evaluated the numbers of coronary segments with coronary atherosclerotic plaques and the plaque characteristics, including significant luminal stenosis (≥70%), positive remodeling, calcified plaque (≥120HU), non-calcified plaque (<120HU), and low attenuation plaque (<60HU). High-risk coronary plaque was defined as positive remodeling or low attenuation plaque.
Results: There were no significant differences in age, gender, body mass index, prevalence of hypertension and dyslipidemia, LDL-cholesterol level, and estimated glomerular filtration rate between these groups. CCTA revealed that higher group had a higher number of coronary segments with non-calcified plaque (2.44 vs. 1.52 segments per patient, p=0.003), high-risk plaque (1.49 vs. 0.73 per patient, p=0.001), and significant luminal stenosis (1.28 vs. 0.63 segments per patient, p=0.006) as compared to lower group. Multivariate analysis showed that HbA1c ≥6.5% was the strongest determinants of numbers of high-risk plaque segments in patients with type 2 DM.
Conclusion: High-risk coronary plaques were more frequently detected in type 2 DM patients with HbA1c ≥6.5%, which suggests that lowering HbA1c below 6.5% might reduce the risk of future adverse coronary events.
- © 2013 by American Heart Association, Inc.