title: Diabetes as an independent predictor of high atherosclerotic burden assessed by coronary computed tomography angiography: the coronary artery disease equivalent revisited.
abstract: (1) To study the prevalence and severity of coronary artery disease (CAD) in diabetic patients. (2) To provide a detailed characterization of the coronary atherosclerotic burden, including the localization, degree of stenosis and plaque composition by coronary computed tomography angiography (CCTA). Single center prospective registry including a total of 581 consecutive stable patients (April 2011-March 2012) undergoing CCTA (Dual-source CT) for the evaluation of suspected CAD without previous myocardial infarction or revascularization procedures. Different coronary plaque burden indexes and plaque type and distribution patterns were compared between patients with (n = 85) and without diabetes (n = 496). The prevalence of CAD (any plaque; 74.1 vs. 56%; p = 0.002) and obstructive CAD (≥50% stenosis; 31.8 vs. 10.3%; p < 0.001) were significantly higher in diabetic patients. The remaining coronary atherosclerotic burden indexes evaluated (plaque in LM-3v-2v with prox. LAD; SIS; SSS; CT-LeSc) were also significantly higher in diabetic patients. In the per segment analysis, diabetics had a higher percentage of segments with plaque in every vessel (2.6/13.1/7.5/10.5% for diabetics vs. 1.4/7.1/3.3/4.4% for nondiabetics for LM, LAD, LCx, RCA respectively; p < 0.001 for all) and of both calcified (19.3 vs. 9.2%, p < 0.001) and noncalcified or mixed types (14.4 vs. 7.0%; p < 0.001); the ratio of proximal-to-distal relative plaque distribution (calculated as LM/proximal vs. mid/distal/branches) was lower for diabetics (0.75 vs. 1.04; p = 0.009). Diabetes was an independent predictor of CAD and was also associated with more advanced CAD, evaluated by indexes of coronary atherosclerotic burden. Diabetics had a significantly higher prevalence of plaques in every anatomical subset and for the different plaque composition. In this report, the relative geographic distribution of the plaques within each subgroup, favored a more mid-to-distal localization in the diabetic patients.
authors.affiliation: Cardiology Department, Centro Hospitalar Lisboa Ocidental, Av. Prof. Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal. paraujogoncalves@yahoo.co.uk
authors.forename: Pedro
authors.initials: P
authors.lastname: de Araújo Gonçalves
authors.forename: Hector M
authors.initials: HM
authors.lastname: Garcia-Garcia
authors.forename: Maria Salomé
authors.initials: MS
authors.lastname: Carvalho
authors.forename: Helder
authors.initials: H
authors.lastname: Dores
authors.forename: Pedro Jeronimo
authors.initials: PJ
authors.lastname: Sousa
authors.forename: Hugo
authors.initials: H
authors.lastname: Marques
authors.forename: Antonio
authors.initials: A
authors.lastname: Ferreira
authors.forename: Nuno
authors.initials: N
authors.lastname: Cardim
authors.forename: Rui Campante
authors.initials: RC
authors.lastname: Teles
authors.forename: Luís
authors.initials: L
authors.lastname: Raposo
authors.forename: Henrique Mesquita
authors.initials: HM
authors.lastname: Gabriel
authors.forename: Manuel
authors.initials: M
authors.lastname: Almeida
authors.forename: Ana
authors.initials: A
authors.lastname: Aleixo
authors.forename: Miguel Mota
authors.initials: MM
authors.lastname: Carmo
authors.forename: Francisco Pereira
authors.initials: FP
authors.lastname: Machado
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011174:Portugal / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed