title: Impact of diabetes duration on the extent and severity of coronary atheroma burden and long-term clinical outcome in asymptomatic type 2 diabetic patients: evaluation by Coronary CT angiography.
abstract: OBJECTIVE
  We investigated the association between diabetes duration and the extent and severity of coronary artery disease (CAD) as well as long-term clinical outcomes using coronary computed tomography angiography (CCTA) in asymptomatic type 2 diabetic patients.
  
  
  RESULTS
  We analysed 933 asymptomatic type 2 diabetic patients without known CAD who underwent CCTA. Patients were divided into three groups according to the duration of diabetes: <5 years, 5-10 years, and ≥10 years. Stenosis by CCTA was scored as none (0%), non-obstructive (1-49%), or obstructive (≥50%) for each coronary artery segment. For these patients, we compared the prevalence, extent, and severity of CAD, including coronary artery calcium score (CACS), atheroma burden obstructive score (ABOS), segment involvement score (SIS), and segment stenosis score (SSS). Major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, non-fatal myocardial infarction, and stroke, within a follow-up period were also compared.Patients with longer duration of diabetes possessed higher rates of obstructive CAD (P < 0.001). Patients with longer duration of diabetes also manifested greater degree of CACS, ABOS, SIS, and SSS (P < 0.001 for all) with associated higher rate of MACCE (P = 0.025). Presence of obstructive CAD as assessed by CCTA was an independent predictor of MACCE after adjusting for confounding risk factors (hazard ratio: 1.979, confidence interval: 1.178-3.327, P = 0.010).
  
  
  CONCLUSIONS
  In asymptomatic diabetic patients, longer diabetes duration is associated with a higher prevalence, extent, and severity of CAD as well as risk of MACCE. Moreover, greater CAD burden increases the risk of MACCE independent of co-existing CAD risk factors.
authors.affiliation: Cardiovascular Center and Cardiology Division, St Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Jin-Jin
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Cardiovascular Center and Cardiology Division, St Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Hwang
authors.affiliation: Cardiovascular Center and Cardiology Division, Incheon St Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.
authors.forename: Ik Jun
authors.initials: IJ
authors.lastname: Choi
authors.affiliation: Cardiovascular Center and Cardiology Division, Uijeongbu St Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea.
authors.forename: Eun-Ho
authors.initials: EH
authors.lastname: Choo
authors.affiliation: Cardiovascular Center and Cardiology Division, Bucheon St Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea.
authors.forename: Sungmin
authors.initials: S
authors.lastname: Lim
authors.affiliation: Cardiovascular Center and Cardiology Division, Uijeongbu St Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea.
authors.forename: Jae-Kyung
authors.initials: JK
authors.lastname: Kim
authors.affiliation: Cardiovascular Center and Cardiology Division, Seoul St Mary's Hospital, The Catholic University of Korea, 505 Banpodong, Seochogu, Seoul 137-701, Republic of Korea.
authors.forename: Yoon-Seok
authors.initials: YS
authors.lastname: Koh
authors.affiliation: Cardiovascular Center and Cardiology Division, St Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Dong-Bin
authors.initials: DB
authors.lastname: Kim
authors.affiliation: Cardiovascular Center and Cardiology Division, St Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Sung-Won
authors.initials: SW
authors.lastname: Jang
authors.affiliation: Cardiovascular Center and Cardiology Division, St Paul's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Cho
authors.affiliation: Cardiovascular Center and Cardiology Division, Uijeongbu St Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea.
authors.forename: Jong Min
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Cardiovascular Center and Cardiology Division, Seoul St Mary's Hospital, The Catholic University of Korea, 505 Banpodong, Seochogu, Seoul 137-701, Republic of Korea.
authors.forename: Pum-Joon
authors.initials: PJ
authors.lastname: Kim
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Jae-Hyoung
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Radiology, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Jung Im
authors.initials: JI
authors.lastname: Jung
authors.affiliation: Cardiovascular Center and Cardiology Division, Seoul St Mary's Hospital, The Catholic University of Korea, 505 Banpodong, Seochogu, Seoul 137-701, Republic of Korea.
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
authors.affiliation: Department of Radiology, Weill Cornell Medical College and the New York Presbyterian Hospital, New York, NY, USA.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Cardiovascular Center and Cardiology Division, Seoul St Mary's Hospital, The Catholic University of Korea, 505 Banpodong, Seochogu, Seoul 137-701, Republic of Korea kiyuk@catholic.ac.kr.
authors.forename: Kiyuk
authors.initials: K
authors.lastname: Chang
mesh_terms: D000368:Aged; D002423:Cause of Death; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide
keywords: coronary CT angiography; coronary artery disease; diabetes