title: Coronary atherosclerotic burden vs. coronary vascular function in diabetic and nondiabetic patients with normal myocardial perfusion: a propensity score analysis.
abstract: OBJECTIVE
  To assess the relationship between coronary atherosclerotic burden and vascular function in diabetic and nondiabetic patients after balancing for coronary risk factors.
  
  
  METHODS
  We studied 672 patients without overt coronary artery disease and normal myocardial perfusion on stress82Rb PET/CT imaging. To account for differences in baseline characteristics between diabetic patients and nondiabetic patients, we created a propensity score-matched cohort considering clinical variables and coronary risk factors.
  
  
  RESULTS
  Before matching, diabetic patients had higher coronary artery calcium (CAC) scores (p < 0.001) and lower coronary flow reserve (CFR; p < 0.001) than nondiabetic patients. After matching, CAC scores were comparable between diabetic and nondiabetic patients, but diabetic patients still had lower hyperaemic myocardial blood flow (p < 0.001) and CFR (p < 0.05). Patients were categorized by ln(CAC score) quartiles. There was a decrease in CFR with increasing CAC score quartile in both diabetic patients (p for trend < 0.01) and nondiabetic patients (p for trend < 0.005). Diabetes was associated with lower CFR across quartile categories (p < 0.002). In a multivariable linear regression analysis, CAC score was inversely related to CFR in both diabetic patients (p < 0.05) and nondiabetic patients (p < 0.001).
  
  
  CONCLUSIONS
  Diabetic patients had higher CAC scores than nondiabetic patients, but the difference disappeared when clinical characteristics were taken into account. Of note, diabetic patients also had lower CFR regardless of CAC score than nondiabetic patients after matching. Thus, coronary atherosclerotic burden and vascular function have to be seen as two different entities.
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Assante
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.|Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Wanda
authors.initials: W
authors.lastname: Acampa
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Zampella
authors.affiliation: Nuclear Medicine Center, Central Manchester University Teaching Hospitals, Manchester, UK.
authors.forename: Parthiban
authors.initials: P
authors.lastname: Arumugam
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Nappi
authors.affiliation: Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Gaudieri
authors.affiliation: Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Panico
authors.affiliation: Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Magliulo
authors.affiliation: Nuclear Medicine Center, Central Manchester University Teaching Hospitals, Manchester, UK.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Tonge
authors.affiliation: Department of Translational Medical Sciences, University Federico II, Naples, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Petretta
authors.affiliation: Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy. cuocolo@unina.it.
authors.forename: Alberto
authors.identifier: http://orcid.org/0000-0003-3431-7658
authors.initials: A
authors.lastname: Cuocolo
mesh_terms: D000375:Aging / Q000378:metabolism / Q000502:physiology; D002118:Calcium / Q000378:metabolism; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003331:Coronary Vessels / Q000378:metabolism / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D055414:Myocardial Perfusion Imaging; D000072078:Positron Emission Tomography Computed Tomography; D057216:Propensity Score; D012307:Risk Factors
chemical_list: D002118:Calcium
keywords: Cardiovascular risk factors; Coronary artery calcium; Coronary flow reserve; Diabetes mellitus