title: Coronary atherosclerosis burden by coronary computed tomography in type II diabetes with preclinical non-obstructive carotid atherosclerosis and without inducible myocardial ischemia.
abstract: OBJECTIVE
  To quantify cardiovascular risk in persons with type-2 diabetes (DM) and established carotid atherosclerosis, without inducible myocardial ischemia by stress imaging.
  
  
  METHODS
  We selected clinically healthy DM and subjects without DM (nonDM, controls) with non-obstructive carotid atherosclerosis and without significant coronary artery disease (CAD) by stress echocardiography. Coronary flow velocity reserve (CFR) was assessed during stress echocardiography. In those with negative stress imaging, coronary artery calcium (CAC) assessment by computed tomography (CT) was proposed. Outcome at 180-day follow-up was performed by visits or telephone interview.
  
  
  RESULTS
  Total CAC was greater in DM (n=19) than in nonDM (n=19, CAC: 225±158 vs 78±65Agatston units, 156±161 vs 53±51 in the left anterior descendent artery, both p<0.05). Coronary stenosis burden was greater in DM than in nonDM, albeit <75% in all cases; CFR was lower in DM than nonDM (p<0.05). Mean age was slightly higher (69±6 vs 64±12, p>0.2), and male gender tended to be less frequent (63 vs 79%) with DM than with nonDM; all subjects showed dyslipidemia, and almost all had arterial hypertension. Based on CAC, a 10-year cardiovascular risk was 10-20% in 78% of the DM and in 28% of the non-DM, and was >20% in 11% of the DM but in none of the nonDM. A single non-fatal myocardial infarction was recorded within 180days from test, among DM.
  
  
  CONCLUSIONS
  Based on CAC, in the presence of non-obstructive carotid atherosclerosis, asymptomatic DM may show significantly higher CAD burden than nonDM even in the absence of inducible myocardial ischemia.
authors.affiliation: Unit of Cardiology, Department of Heart and Vessels, "S. G. Moscati" National Hospital, Avellino, Italy. Electronic address: vpalmieri68@gmail.com.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmieri
authors.affiliation: Department of Radiology, "S. G. Moscati" National Hospital, Avellino, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Gravino
authors.affiliation: Department of Medicine, Columbia University, New York, NY, USA.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.affiliation: Department of Radiology, "S. G. Moscati" National Hospital, Avellino, Italy.
authors.forename: Armenio
authors.initials: A
authors.lastname: Salvati
authors.affiliation: Department of Radiology, "S. G. Moscati" National Hospital, Avellino, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Lombardi
authors.affiliation: Unit of Cardiology, Department of Heart and Vessels, "S. G. Moscati" National Hospital, Avellino, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Sauro
authors.affiliation: Unit of Cardiology, Department of Heart and Vessels, "S. G. Moscati" National Hospital, Avellino, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rosato
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000209:etiology* / Q000473:pathology; D003324:Coronary Artery Disease / Q000503:physiopathology; D023921:Coronary Stenosis / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000473:pathology; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Atherosclerosis; Calcium score; Computed tomography; Diabetes; Echocardiography