title: Coronary artery plaque volume and obesity in patients with diabetes: the factor-64 study.
abstract: OBJECTIVE
  To determine the relationship between coronary plaque detected with coronary computed tomographic (CT) angiography and clinical parameters and cardiovascular risk factors in asymptomatic patients with diabetes.
  
  
  METHODS
  All patients signed institutional review board-approved informed consent forms before enrollment. Two hundred twenty-four asymptomatic diabetic patients (121 men; mean patient age, 61.8 years; mean duration of diabetes, 10.4 years) underwent coronary CT angiography. Total coronary artery wall volume in all three vessels was measured by using semiautomated software. The coronary plaque volume index (PVI) was determined by dividing the wall volume by the coronary length. The relationship between the PVI and cardiovascular risk factors was determined with multivariable analysis.
  
  
  RESULTS
  The mean PVI (±standard deviation) was 11.2 mm(2) ± 2.7. The mean coronary artery calcium (CAC) score (determined with the Agatston method) was 382; 67% of total plaque was noncalcified. The PVI was related to age (standardized β = 0.32, P < .001), male sex (standardized β = 0.36, P < .001), body mass index (BMI) (standardized β = 0.26, P < .001), and duration of diabetes (standardized β = 0.14, P = .03). A greater percentage of soft plaque was present in younger individuals with a shorter disease duration (P = .02). The soft plaque percentage was directly related to BMI (P = .002). Patients with discrepancies between CAC score and PVI rank quartiles had a higher percentage of soft and fibrous plaque (18.7% ± 3.3 vs 17.4% ± 3.5 [P = .008] and 52.2% ± 7.2 vs 47.2% ± 8.8 [P < .0001], respectively).
  
  
  CONCLUSIONS
  In asymptomatic diabetic patients, BMI was the primary modifiable risk factor that was associated with total and soft coronary plaque as assessed with coronary CT angiography.
authors.affiliation: From the Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Building 10/1C355, Bethesda, MD 20892 (A.C.K., G.C., C.T.S., K.R., D.A.B.); Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah (H.T.M., D.L.L., J.B.M., J.L.A.); Cardiology Division, Department of Medicine, Johns Hopkins University, Baltimore, Md (B.D.R., J.A.C.L.); and Cardiology Division, University of Utah, Salt Lake City, Utah (D.L.L., J.B.M., J.L.A.).
authors.forename: Alan C
authors.initials: AC
authors.lastname: Kwan
authors.forename: Heidi T
authors.initials: HT
authors.lastname: May
authors.forename: George
authors.initials: G
authors.lastname: Cater
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Sibley
authors.forename: Boaz D
authors.initials: BD
authors.lastname: Rosen
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.forename: Karen
authors.initials: K
authors.lastname: Rodriguez
authors.forename: Donald L
authors.initials: DL
authors.lastname: Lappe
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D048909:Diabetes Complications / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
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