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Rezaeian P, Backlund JYC, Zaveri M, Nakanishi R, Matsumoto S, Alani A, Razipour A, Lachin JM, Budoff M. Epicardial and intra-thoracic adipose tissue and cardiovascular calcifications in type 1 diabetes (T1D) in epidemiology of diabetes Interventions and Complications (EDIC): A pilot study. Am J Prev Cardiol 2024; 18:100650. [PMID: 38584607 PMCID: PMC10995972 DOI: 10.1016/j.ajpc.2024.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/06/2024] [Accepted: 03/17/2024] [Indexed: 04/09/2024] Open
Abstract
Objective Coronary artery, aortic valve, and descending aorta calcification (CAC, AVC, DAC) are manifestations of atherosclerosis, and cardiac epicardial adipose tissue (EAT) indicates heart adiposity. This study explored the association between cardiac adipose tissue and cardiovascular calcification in participants with long-standing T1D. Methods EAT and intra-thoracic adipose tissue (IAT) were measured in 100 T1D subjects with cardiac computed tomography (CT) scans in the EDIC study. Volume analysis software was used to measure fat volumes. Spearman correlations were calculated between CAC, AVC, DAC with EAT, and IAT. Associations were evaluated using multiple linear and logistic regression models. Results Participants ranged in age from 32 to 57. Mean EAT, and IAT were 38.5 and 50.8 mm3, respectively, and the prevalence of CAC, AVC, and DAC was 43.6 %, 4.7 %, and 26.8 %, respectively. CAC was positively correlated with age (p-value = 0.0001) and EAT (p-value = 0.0149) but not with AVC and DAC; IAT was not associated with calcified lesions. In models adjusted for age and sex, higher levels of EAT and IAT were associated with higher CAC (p-value < 0.0001 for both) and higher AVC (p-values of 0.0111 and 0.0053, respectively), but not with DAC. The associations with CAC remained significant (p-value < 0.0001) after further adjustment for smoking, systolic blood pressure, BMI, and LDL, while the associations with AVC did not remain significant. Conclusion In participants with T1D, higher EAT and IAT levels are correlated with higher CAC scores. EAT and IAT were not independently correlated with DAC or AVC.
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Affiliation(s)
- Panteha Rezaeian
- Torrance Memorial Physician Network-Cedars-Sinai Health System affiliate, Torrance, CA, USA
| | - Jye-Yu C Backlund
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Mohammed Zaveri
- Department of Medicine Emanate Health Medical Group, West Covina, CA, USA
| | - Rine Nakanishi
- Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
| | - Suguru Matsumoto
- Department of Cardiology, Kouiki Monbetsu Hospital, Hokkaido, Japan
| | - Anas Alani
- Department of Cardiology, University of Loma Linda, Loma Linda, CA, USA
| | - Aryabod Razipour
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - John M Lachin
- The Biostatistics Center, George Washington University, Rockville, MD, USA
| | - Matthew Budoff
- Lindquist Research Institute, Harbor-UCLA Medical Center, 1124W Carson St, Torrance, CA 90502, USA
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Serés-Noriega T, Perea V, Amor AJ. Screening for Subclinical Atherosclerosis and the Prediction of Cardiovascular Events in People with Type 1 Diabetes. J Clin Med 2024; 13:1097. [PMID: 38398409 PMCID: PMC10889212 DOI: 10.3390/jcm13041097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
People with type 1 diabetes (T1D) have a high cardiovascular disease (CVD) risk, which remains the leading cause of death in this population. Despite the improved control of several classic risk factors, particularly better glycaemic control, cardiovascular morbidity and mortality continue to be significantly higher than in the general population. In routine clinical practice, estimating cardiovascular risk (CVR) in people with T1D using scales or equations is often imprecise because much of the evidence comes from pooled samples of people with type 2 diabetes (T2D) and T1D or from extrapolations of studies performed on people with T2D. Given that T1D onsets at a young age, prolonged exposure to the disease and its consequences (e.g., hyperglycaemia, changes in lipid metabolism or inflammation) have a detrimental impact on cardiovascular health. Therefore, it is critical to have tools that allow for the early identification of those individuals with a higher CVR and thus be able to make the most appropriate management decisions in each case. In this sense, atherosclerosis is the prelude to most cardiovascular events. People with diabetes present pathophysiological alterations that facilitate atherosclerosis development and that may imply a greater vulnerability of atheromatous plaques. Screening for subclinical atherosclerosis using various techniques, mainly imaging, has proven valuable in predicting cardiovascular events. Its use enables the reclassification of CVR and, therefore, an individualised adjustment of therapeutic management. However, the available evidence in people with T1D is scarce. This narrative review provides and updated overview of the main non-invasive tests for detecting atherosclerosis plaques and their association with CVD in people with T1D.
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Affiliation(s)
- Tonet Serés-Noriega
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, 08036 Barcelona, Spain
| | - Verónica Perea
- Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
| | - Antonio J. Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, 08036 Barcelona, Spain
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Yang SC, Wu YJ, Wang WH, Wu FZ. Gender Differences in Subclinical Coronary Atherosclerosis in the Asian Population With a Coronary Artery Calcium Score of Zero. Am J Cardiol 2023; 203:29-36. [PMID: 37481809 DOI: 10.1016/j.amjcard.2023.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/15/2023] [Accepted: 06/24/2023] [Indexed: 07/25/2023]
Abstract
There is little evidence on whether gender difference influences the incidence of subclinical coronary atherosclerosis in Asian populations with a 0 score. In this study, we investigated the influence of age and gender on the extent of subclinical coronary atherosclerotic burden within a healthy Asian population with a 0 coronary artery calcium (CAC) score. A total of 934 participants (320 women and 614 men) from Taiwan's Han Chinese population with an initial CAC score of 0 were included in this study. They underwent 2 consecutive cardiac computed tomography scans over a clinical follow-up period of 4.35 ± 2.37 years. Clinical information and laboratory measurements were collected for analysis. Compared with the female group, the male group demonstrated significantly higher rates of subclinical CAC progression (27.4% vs 13.8%, p <0.001). Across the age group deciles (≤40, 41 to 50, 51 to 60, ≥61 years), the male group had a higher prevalence of subclinical CAC progression than the female group. For the subclinical CAC progression, the logistic regression model demonstrated that age, gender (male gender), cholesterol level, and follow-up period were statistically significant parameters. In conclusion, these findings support that a gender difference impacts the long-term natural course of subclinical coronary calcification conversion in women compared with men, suggesting that the gender-based effect on coronary CAC conversion plays an important role in subclinical coronary atherosclerosis risk stratification in personalized preventive medicine.
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Affiliation(s)
- Shu-Ching Yang
- Intelligent Electronic Commerce Research Center, Institute of Education, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yun-Ju Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen-Hwa Wang
- Department of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Fu-Zong Wu
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Education, National Sun Yat-Sen University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan; Faculty of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan.
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4
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Jonas RA, Crabtree TR, Jennings RS, Marques H, Katz RJ, Chang HJ, Stuijfzand WJ, van Rosendael AR, Choi JH, Doh JH, Her AY, Koo BK, Nam CW, Park HB, Shin SH, Cole J, Gimelli A, Khan MA, Lu B, Gao Y, Nabi F, Nakazato R, Schoepf UJ, Driessen RS, Bom MJ, Thompson RC, Jang JJ, Ridner M, Rowan C, Avelar E, Généreux P, Knaapen P, de Waard GA, Pontone G, Andreini D, Al-Mallah MH, Guglielmo M, Bax JJ, Earls JP, Min JK, Choi AD, Villines TC. Diabetes, Atherosclerosis, and Stenosis by AI. Diabetes Care 2023; 46:416-424. [PMID: 36577120 PMCID: PMC9887618 DOI: 10.2337/dc21-1663] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/14/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study evaluates the relationship between atherosclerotic plaque characteristics (APCs) and angiographic stenosis severity in patients with and without diabetes. Whether APCs differ based on lesion severity and diabetes status is unknown. RESEARCH DESIGN AND METHODS We retrospectively evaluated 303 subjects from the Computed TomogRaphic Evaluation of Atherosclerotic Determinants of Myocardial IsChEmia (CREDENCE) trial referred for invasive coronary angiography with coronary computed tomographic angiography (CCTA) and classified lesions as obstructive (≥50% stenosed) or nonobstructive using blinded core laboratory analysis of quantitative coronary angiography. CCTA quantified APCs, including plaque volume (PV), calcified plaque (CP), noncalcified plaque (NCP), low-density NCP (LD-NCP), lesion length, positive remodeling (PR), high-risk plaque (HRP), and percentage of atheroma volume (PAV; PV normalized for vessel volume). The relationship between APCs, stenosis severity, and diabetes status was assessed. RESULTS Among the 303 patients, 95 (31.4%) had diabetes. There were 117 lesions in the cohort with diabetes, 58.1% of which were obstructive. Patients with diabetes had greater plaque burden (P = 0.004). Patients with diabetes and nonobstructive disease had greater PV (P = 0.02), PAV (P = 0.02), NCP (P = 0.03), PAV NCP (P = 0.02), diseased vessels (P = 0.03), and maximum stenosis (P = 0.02) than patients without diabetes with nonobstructive disease. APCs were similar between patients with diabetes with nonobstructive disease and patients without diabetes with obstructive disease. Diabetes status did not affect HRP or PR. Patients with diabetes had similar APCs in obstructive and nonobstructive lesions. CONCLUSIONS Patients with diabetes and nonobstructive stenosis had an association to similar APCs as patients without diabetes who had obstructive stenosis. Among patients with nonobstructive disease, patients with diabetes had more total PV and NCP.
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Affiliation(s)
- Rebecca A. Jonas
- Department of Internal Medicine, Thomas Jefferson University Medical Center; Philadelphia, PA
- Corresponding author: Rebecca A. Jonas,
| | | | | | - Hugo Marques
- Faculdade de Medicina da Universidade Católica Portuguesa, Lisboa, Portugal
| | - Richard J. Katz
- The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | - Wijnand J. Stuijfzand
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | | | | | - Joon-Hyung Doh
- Division of Cardiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Ae-Young Her
- Kang Won National University Hospital, Chuncheon, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Chang-Wook Nam
- Cardiovascular Center, Keimyung University Dongsan Hospital, Daegu, South Korea
| | - Hyung-Bok Park
- Division of Cardiology, Department of Internal Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, South Korea
| | - Sang-Hoon Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Women’s University Seoul Hospital, Seoul, South Korea
| | - Jason Cole
- Mobile Cardiology Associates, Mobile, AL
| | - Alessia Gimelli
- Department of Imaging, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Bin Lu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | - Yang Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China
| | | | - Ryo Nakazato
- Cardiovascular Center, St. Luke’s International Hospital, Tokyo, Japan
| | | | - Roel S. Driessen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel J. Bom
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | | | - James J. Jang
- Kaiser Permanente San Jose Medical Center, San Jose, CA
| | | | - Chris Rowan
- Renown Heart and Vascular Institute, Reno, NV
| | - Erick Avelar
- Oconee Heart and Vascular Center at St Mary’s Hospital, Athens, GA
| | - Philippe Généreux
- Gagnon Cardiovascular Institute at Morristown Medical Center, Morristown, NJ
| | - Paul Knaapen
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Guus A. de Waard
- Amsterdam University Medical Center, VU University Medical Center, Amsterdam, the Netherlands
| | - Gianluca Pontone
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Daniele Andreini
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | | | - Marco Guglielmo
- Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Amsterdam, the Netherlands
| | | | | | - Andrew D. Choi
- The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Todd C. Villines
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA
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Feijó BMXCRR, Mendonça RM, Egito EST, Lima DN, Campos JTADM, Lima JG. Coronary arterial calcification in patients with congenital generalised lipodystrophy: A case series. Clin Endocrinol (Oxf) 2022; 97:863-866. [PMID: 35864565 DOI: 10.1111/cen.14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Roberto Moreno Mendonça
- Centro de Ciências da Saúde, Graduate Program in Health Sciences, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Eryvaldo Socrates Tabosa Egito
- Centro de Ciências da Saúde, Graduate Program in Health Sciences, UFRN, Natal, Rio Grande do Norte, Brazil
- Department of Pharmacy, UFRN, Natal, Rio Grande do Norte, Brazil
| | - Debora Nobrega Lima
- Centro de Ciências Médicas, Federal University of Pernambuco (UFPE), Recife, Pernambuco, Brazil
| | | | - Josivan Gomes Lima
- Centro de Ciências da Saúde, Graduate Program in Health Sciences, UFRN, Natal, Rio Grande do Norte, Brazil
- Department of Clinical Medicine, UFRN, Natal, Rio Grande do Norte, Brazil
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6
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Norwitz NG, Soto-Mota A, Feldman D, Parpos S, Budoff M. Case Report: Hypercholesterolemia "Lean Mass Hyper-Responder" Phenotype Presents in the Context of a Low Saturated Fat Carbohydrate-Restricted Diet. Front Endocrinol (Lausanne) 2022; 13:830325. [PMID: 35498420 PMCID: PMC9048595 DOI: 10.3389/fendo.2022.830325] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Emerging evidence suggests that "leanness" and good metabolic health markers may predict larger increases in LDL cholesterol (LDL-C) in response to carbohydrate restriction. Specifically, a recent cohort study demonstrated an inverse association between BMI and LDL-C change among individuals on carbohydrate-restricted diets and identified a subgroup of "Lean Mass Hyper-Responders" (LMHR) who exhibit exceptional increases in LDL-C, in the context of low triglycerides and high HDL-C. We present the case of one subject, LM, who adopted a ketogenic diet for management of ulcerative colitis. He subsequently experienced an increase in LDL-C from 95 to 545 mg/dl, at peak, in association with HDL-C >100 mg/dl and triglycerides ~40 mg/dl, typical of the emergent LMHR phenotype. Assessments of LM's dietary intake, lipid panels, and BMI are consistent with prior data and suggest that the LMHR phenomenon is not dependent on saturated fat intake but inversely associates with BMI changes. Finally, computed tomography angiography conducted on LM after over 2 years of hypercholesterolemia revealed no evidence of calcified or non-calcified plaque.
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Affiliation(s)
- Nicholas G. Norwitz
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Nicholas G. Norwitz,
| | - Adrian Soto-Mota
- Metabolic Diseases Research Unit, National Institute for Medical Sciences and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - David Feldman
- Citizen Science Foundation, Las Vegas, NV, United States
| | - Stefanos Parpos
- Elfers Cardiovascular Center, Mass-General Brigham Newton-Wellesley Hospital, Newton, MA, United States
- Department of Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Matthew Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
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7
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Piko N, Bevc S, Ekart R, Petreski T, Vodošek Hojs N, Hojs R. Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk. World J Diabetes 2021; 12:975-996. [PMID: 34326949 PMCID: PMC8311487 DOI: 10.4239/wjd.v12.i7.975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/04/2021] [Accepted: 04/26/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising. Diabetes mellitus by itself is linked to adverse cardiovascular events, and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk. The culmination of traditional (male gender, smoking, advanced age, obesity, arterial hypertension and dyslipidemia) and non-traditional risk factors (anemia, inflammation, proteinuria, volume overload, mineral metabolism abnormalities, oxidative stress, etc.) contributes to advanced atherosclerosis and increased cardiovascular risk. To decrease the morbidity and mortality of these patients due to cardiovascular causes, timely and efficient cardiovascular risk assessment is of huge importance. Cardiovascular risk assessment can be based on laboratory parameters, imaging techniques, arterial stiffness parameters, ankle-brachial index and 24 h blood pressure measurements. Newer methods include epigenetic markers, soluble adhesion molecules, cytokines and markers of oxidative stress. In this review, the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.
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Affiliation(s)
- Nejc Piko
- Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Sebastjan Bevc
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
- Medical Faculty, University of Maribor, Maribor 2000, Slovenia
| | - Robert Ekart
- Department of Dialysis, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
- Medical Faculty, University of Maribor, Maribor 2000, Slovenia
| | - Tadej Petreski
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
- Medical Faculty, University of Maribor, Maribor 2000, Slovenia
| | - Nina Vodošek Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Radovan Hojs
- Department of Nephrology, Clinic for Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
- Medical Faculty, University of Maribor, Maribor 2000, Slovenia
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8
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Birudaraju D, Cherukuri L, Kinninger A, Dahal S, Lakshmanan S, Rezvanizadeh V, Ghanem AK, Flores F, Hamal S, Pozon RG, Adudodla N, Tayek JA, Roy SK, Budoff MJ. Prevalence of normal coronary arteries by coronary computed tomography angiography (CCTA) in patients with type 2 diabetes mellitus from Semaglutide Treatment on Coronary Plaque Progression (STOP) trial. J Diabetes Complications 2021; 35:107840. [PMID: 33419635 DOI: 10.1016/j.jdiacomp.2020.107840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Coronary artery disease (CAD) is leading cause of morbidity and mortality among type 2 diabetics (T2DM). METHODS 140 T2DM will be enrolled in randomized, double blind, placebo controlled Semaglutide Treatment On Coronary Plaque Progression (STOP) trial to determine effect of weekly subcutaneous semaglutide on coronary plaque progression. All participants will undergo Coronary Artery Calcium (CAC) Scoring and Coronary Computed Tomography Angiography (CCTA) at our center. A Fisher test, ANOVA and Kruskal Wallis were used. RESULTS As of May 2020, 87 patients (81%) randomized (mean age 56.4 ± 8.4 yrs. and 62% male) with documented CAD by CCTA. Approximately 20% of screened study population were screen failed due to normal coronaries (n= 14) or HbA1C<7 (n=7). Of interest, 14 persons with diabetes with normal coronaries (no calcification) were significantly more likely to be females (21% vs 62%), have higher glomerular filtration rate (106.5 ± 19.4 vs 89.9 ± 22.6 mL/min/1.73m2; p= 0.006), and younger (53.4 ± 9.0 vs 56.4 ± 8.4 yrs.; p=0.02) than those who were randomized. CONCLUSION Among T2DM, there is a significant portion who have normal coronary arteries and may have a better prognosis. Excluding these participants from cardiovascular studies may improve power and decrease sample size.
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Affiliation(s)
- Divya Birudaraju
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Lavanya Cherukuri
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - April Kinninger
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Suraj Dahal
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Suvasini Lakshmanan
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Vahid Rezvanizadeh
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ahmed K Ghanem
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ferdinand Flores
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Sajad Hamal
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ryan G Pozon
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Nishitha Adudodla
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - John A Tayek
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Sion K Roy
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA.
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10
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Jenkins A, Januszewski A, O’Neal D. The early detection of atherosclerosis in type 1 diabetes: why, how and what to do about it. Cardiovasc Endocrinol Metab 2019; 8:14-27. [PMID: 31646294 PMCID: PMC6739889 DOI: 10.1097/xce.0000000000000169] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/22/2019] [Indexed: 12/11/2022]
Abstract
The major cause of morbidity and often premature mortality in people with type I diabetes (T1D) is cardiovascular disease owing to accelerated atherosclerosis. We review publications relating to the rationale behind, and clinical tests for, detecting and treating early atherosclerosis in people with T1D. Currently available tools for atherosclerosis assessment include risk equations using vascular risk factors, arterial intima-media thickness, the ankle-brachial index, coronary artery calcification and angiography, and for more advanced lesions, intravascular ultrasound and optical coherence tomography. Evolving research tools include risk equations incorporating novel clinical, biochemical and molecular tests; vascular MRI and molecular imaging. As yet there is little information available to quantify early atherosclerosis. With better means to control the vascular risk factors, such as hypertension, dyslipidaemia and glycaemic control, and emerging therapies to control novel risk factors, further epidemiologic and clinical trials are merited to facilitate the translation into clinical practice of robust means to detect, monitor and treat early atherosclerosis in those with T1D.
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Affiliation(s)
- Alicia Jenkins
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales
- Department of Endocrinology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
| | - Andrzej Januszewski
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales
- Department of Endocrinology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
| | - David O’Neal
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales
- Department of Endocrinology, St. Vincent’s Hospital, Fitzroy, Victoria, Australia
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11
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Wang C, Tian X, Xia W, Liu Q. Study on correlation between property of coronary artery lesion and degree of coronary artery stenosis of elderly patients with coronary heart disease. Pak J Med Sci 2019; 35:236-240. [PMID: 30881430 PMCID: PMC6408652 DOI: 10.12669/pjms.35.1.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 10/08/2018] [Accepted: 12/25/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To discuss the influence of coronary artery lesion of elderly patients with coronary heart disease (CHD) on left ventricular remodeling. METHODS Retrospective selection method was used to choose 80 elderly CHD patients who received coronary angiogram examination in Baoding First Central Hospital from January 2014 to February 2018 as the objects of study. According to coronary artery lesion, the patients were classified into single vessel lesion group (single vessel group) and multi-vessel lesion group (multi-vessel group, the number of lesion vessels≧2). Single vessel group included 60 patients, and multi-vessel group includes 20 patients. Intravascular unltrasound was applied to record coronary plaque property of all patients and transthoracic echocardiography was used to record left ventricular remodeling. Later correlation analysis was carried out. RESULTS The proportion of calcified plaque and mixed plaque was higher than that of single vessel group, and the differences had statistical significance (P<0.05). Left ventricular end diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) of multi-vessel group were higher than that of single vessel group, while left ventricular ejection fraction (LVEF) was lower than that of single vessel group. The differences had statistical significance (P<0.05). Linear correlation analysis showed coronary artery lesion was positively correlated with LVEF and calcified plaque (r=0.287, 0.371, P<0.05). Multiple linear regression analysis showed LVEF, calcified plaque and LDL-C were independent risk factors of multi-vessel coronary artery lesion of old CHD patients (P<0.05). CONCLUSION The number of coronary artery lesions is significantly correlated with left ventricular remodeling, and can increase the proportion of calcified plaque and mixed plaque, thus leading to left ventricular remodeling abnormity.
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Affiliation(s)
- Chao Wang
- Chao Wang, Department of Cardiology, Baoding First Hospital Baoding 071000, P. R. China
| | - Xiang Tian
- Qianmei Liu, Department of Cardiology, Baoding First Hospital Baoding 071000, P. R. China
| | - Wei Xia
- Wei Xia, Department of Cardiology, Baoding First Hospital Baoding 071000, P. R. China
| | - Qianmei Liu
- Xiang Tian, Department of Cardiology, Baoding First Hospital Baoding 071000, P. R. China
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12
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Presence, Characteristics, and Volumes of Coronary Plaque Determined by Computed Tomography Angiography in Young Type 2 Diabetes Mellitus. Am J Cardiol 2017; 119:1566-1571. [PMID: 28343599 DOI: 10.1016/j.amjcard.2017.02.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/22/2022]
Abstract
Prevention and management of coronary artery disease (CAD) is of great concern in patients with diabetes mellitus. Although the impact of coronary atherosclerosis is described well for subjects older than 40 years, the prevalence and types of coronary atherosclerosis in young patients are not well known. The aim of this study was to evaluate the prevalence, extent, severity, and volumes of coronary plaque in type 2 diabetes mellitus (T2DM) population younger than of 40 years. This prospective study enrolled 181 subjects (25-40 year old) undergoing coronary computed tomography angiography, with 86 T2DM and 95 nondiabetic age/gender-matched subjects. Coronary artery calcium (CAC), plaque assessment including total segment stenosis (sum of individual segmental stenosis), total plaque scores (sum of semiquantitative segmental plaque burden), segment involvement scores (number of segments with plaque) were evaluated. In addition, we quantitatively measured plaque volumes in total, fibrous, fibrous fatty, dense calcified, and low-attenuation plaque using novel plaque software. Compared with nondiabetic patients, the prevalence of CAD, calcified, and noncalcified plaques was higher in patients with T2DM (19% vs 58%; p <0.001). In patients with a zero CAC, T2DM had a higher prevalence (46%) of noncalcified plaque (p <0.0001). In multivariate linear regression models after adjusting for traditional cardiovascular risk factors, increased total segmental stenosis, total plaque scores, and segment involvement scores were associated with T2DM. Regarding quantitative plaque assessment, all volumes in noncalcified plaque type were approximately threefold higher in patients with T2DM. In conclusion, young patients with T2DM are susceptible to premature CAD with more calcified and noncalcified plaques. Early prevention program using computed tomography angiography might be helpful in identifying young diabetic patients with subclinical atherosclerosis.
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Ritsinger V, Hero C, Svensson AM, Saleh N, Lagerqvist B, Eeg-Olofsson K, Norhammar A. Mortality and extent of coronary artery disease in 2776 patients with type 1 diabetes undergoing coronary angiography: A nationwide study. Eur J Prev Cardiol 2017; 24:848-857. [PMID: 28084092 DOI: 10.1177/2047487316687860] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background In a modern perspective there is limited information on mortality by affected coronary vessels assessed by coronary angiography in patients with type 1 diabetes. The aim of the present study was to characterise distribution of coronary artery disease and impact on long-term mortality in patients with type 1 diabetes undergoing coronary angiography. Design The design of this research was a nationwide population-based cohort study. Methods Individuals ( n = 2776) with type 1 diabetes undergoing coronary angiography 2001-2013 included in the Swedish National Diabetes Registry and Swedish Coronary Angiography and Angioplasty Registry were followed for mortality until 31 December 2013 (mean 7.1 years). In 79% the indication was stable or acute coronary artery disease. Coronary artery disease was categorised into normal (21%), one- (23%), two- (18%), three- (29%) and left main-vessel disease (8%). Results Mean age was 57 years and 58% were male. Mean diabetes duration was 35 years, glycated haemoglobin was 67 mmol/mol and 44% had normal or one-vessel disease. In multivariate Cox proportional analyses hazard ratio for mortality compared with normal findings was 1.09 (95% confidence interval 0.80-1.48) for one, 1.43 (1.05-1.94) for two, 1.47 (1.10-1.96) for three and 1.90 (1.35-2.68) for left main-vessel disease. Renal failure 2.29 (1.77-2.96) and previous heart failure 1.76 (1.46-2.13) were highly associated with mortality. Standard mortality ratio the first year was 5.55 (4.65-6.56) and decreased to 2.80 (2.18-3.54) after five years. Conclusions In patients with type 1 diabetes referred for coronary angiography mortality is influenced by numbers of affected coronary vessels. The overall mortality rate was higher compared with the general population. These results support early intensive prevention of coronary artery disease in this population.
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Affiliation(s)
- V Ritsinger
- 1 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden.,2 Department of Research and Development, Region Kronoberg, Sweden
| | - C Hero
- 3 Department of Medicine, University of Gothenburg, Sweden
| | | | - N Saleh
- 1 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden
| | - B Lagerqvist
- 5 Department of Medical Sciences, Uppsala University, Sweden
| | - K Eeg-Olofsson
- 3 Department of Medicine, University of Gothenburg, Sweden
| | - A Norhammar
- 1 Unit of Cardiology, Department of Medicine, Solna, Karolinska Institutet & Karolinska University Hospital, Stockholm, Sweden.,6 Capio St Göran's Hospital, Stockholm, Sweden
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14
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Abstract
Cardiovascular events, including myocardial infarction and stroke, are the primary causes of mortality in both type 1 and type 2 diabetes. Affected patients frequently have asymptomatic coronary artery disease. Studies have shown heterogeneity in cardiovascular risk among patients with diabetes. Imaging can help categorize risk of future cardiovascular events by identifying those patients with atherosclerosis, rather than relying on risk prediction based on population-based studies. In this article, we will review the evidence regarding use of atherosclerosis imaging in patients with diabetes to predict risk of coronary heart disease and mortality.
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Affiliation(s)
- Sina Rahmani
- Department of Cardiology, Los Angeles Biomedical Research Institute, 1124 W Carson Street, CDCRC, Torrance, CA, 90502, USA
| | - Rine Nakanishi
- Department of Cardiology, Los Angeles Biomedical Research Institute, 1124 W Carson Street, CDCRC, Torrance, CA, 90502, USA
| | - Matthew J Budoff
- Department of Cardiology, Los Angeles Biomedical Research Institute, 1124 W Carson Street, CDCRC, Torrance, CA, 90502, USA.
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15
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alamir MA, Ellenberg SS, Swerdloff RS, Wenger NK, Mohler ER, Lewis CE, Barrett-Conner E, Nakanishi R, Darabian S, Alani A, Matsumoto S, Nezarat N, Snyder PJ, Budoff MJ. The Cardiovascular Trial of the Testosterone Trials: rationale, design, and baseline data of a clinical trial using computed tomographic imaging to assess the progression of coronary atherosclerosis. Coron Artery Dis 2016; 27:95-103. [PMID: 26554661 PMCID: PMC4738150 DOI: 10.1097/mca.0000000000000321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Data from prior studies have yielded inconsistent results on the association of serum testosterone levels with the risk for cardiovascular disease. There are no clinical trial data on the effects of testosterone replacement therapy on plaque progression. OBJECTIVE We designed a study to investigate the effect of testosterone therapy on coronary artery plaque progression using serial coronary computed tomographic angiography (CCTA). In this paper, we describe the study design, methods, and characteristics of the study population. METHODS The Cardiovascular Trial of the Testosterone Trials (TTrials; NCT00799617) is a double-blind, placebo-controlled trial of 1 year of testosterone therapy in men 65 years or older with clinical manifestations of androgen deficiency and unequivocally low serum testosterone concentrations (<275 ng/dl). CCTA performed at baseline and after 12 months of therapy will determine the effects of testosterone on the progression of the total volume of noncalcified plaques. All scans are evaluated at a central reading center by an investigator blinded to treatment assignment. RESULTS A total of 165 men were enrolled. The average age is 71.1 years, and the average BMI is 30.7. About 9% of men had a history of myocardial infarction, 6% angina, and 10% coronary artery revascularization. A majority reported hypertension and/or high cholesterol; 31.8% reported diabetes. Total noncalcified plaque at baseline showed a slight but nonsignificant trend toward lower plaque volume with higher serum testosterone concentrations (P=0.12). CONCLUSION The Cardiovascular Trial will test the hypothesis that testosterone therapy inhibits coronary plaque progression, as assessed by serial CCTA.
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Affiliation(s)
- Moshrik Abd alamir
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Susan S. Ellenberg
- Center for Clinical Epidemiology & Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronald S. Swerdloff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Nanette K. Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Emory Heart and Vascular Center, Atlanta, GA, USA
| | - Emile R Mohler
- Division of Cardiovascular Disease and Section of Vascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Cora E. Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Barrett-Conner
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rine Nakanishi
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Sirous Darabian
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Anas Alani
- Cardiology Department, University of Florida, Gainesville, FL, USA
| | - Suguru Matsumoto
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Negin Nezarat
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
| | - Peter J. Snyder
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
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Sijbrands EJG, Nieman K, Budoff MJ. Cardiac computed tomography imaging in familial hypercholesterolaemia: implications for therapy and clinical trials. Curr Opin Lipidol 2015; 26:586-92. [PMID: 26780011 DOI: 10.1097/mol.0000000000000249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the present review is to summarize the potential clinical applications of computed tomographic angiography (CTA) in familial hypercholesterolemia so far and recent advances of CTA research in other high-risk patients. RECENT FINDINGS Long-term, aggressively statin-treated, asymptomatic familial hypercholesterolemia patients may still have dramatic coronary artery disease (CAD). A clear association between the presence and the extent of nonobstructive CAD and all-cause mortality was found in the COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry. Notably, baseline statin therapy was associated with a significantly lower mortality for individuals with atherosclerotic plaque on CTA, but not for individuals with normal coronary arteries. SUMMARY CTA imaging has made clear that an increased plaque burden can be present even among asymptomatic, long-term aggressively statin-treated familial hypercholesterolemia patients. In the COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter registry, nonobstructive CAD predicted all-cause mortality and statin treatment improved the life span of persons with nonobstructive CAD. Clinical trials with CTA are required to develop and test identification of CAD and personalized treatment strategies for familial hypercholesterolemia.
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Affiliation(s)
- Eric J G Sijbrands
- aDepartment of Internal MedicinebDepartments of Cardiology and Radiology, Erasmus Medical Center, Rotterdam, The NetherlandscLos Angeles Biomedical Research Institute, Torrance, California, USA
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Cho JY, Sun JS, Sur YK, Park JS, Kang DK. Relationship between left ventricular mass and coronary artery disease in young adults: a single-center study using cardiac computed tomography. Int J Cardiovasc Imaging 2015; 31 Suppl 2:187-96. [DOI: 10.1007/s10554-015-0772-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 09/15/2015] [Indexed: 12/31/2022]
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Daga N, Nasir K, Hamirani Y, Tayek J, Bach P, Li D, Budoff MJ. Prevalence and severity of coronary artery calcium in young persons with diabetes. J Cardiovasc Comput Tomogr 2013; 7:241-7. [PMID: 24148777 DOI: 10.1016/j.jcct.2013.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 04/14/2013] [Accepted: 08/16/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Currently, American Diabetes Association guidelines suggest statin use among persons with diabetes mellitus aged >40 years. The presence of calcified plaque in coronary arteries is a sensitive surrogate of coronary artery disease and has been shown to be an independent predictor of mortality and cardiac events. OBJECTIVE We aimed to assess the prevalence and severity of calcified plaque in coronary arteries in patients aged <40 years with and without diabetes. METHODS We included 3723 asymptomatic patients aged <40 years who had undergone coronary calcium scanning. Clinical and demographic data were collected. Agatston score was categorized into Agatston score 0 as normal, 1 to 99 as low, 100 to 399 as intermediate, and ≥400 as severe; and statistical analysis was performed. RESULTS The study population consisted of 4% persons with diabetes (n = 142) and 56% men with a mean age of 35 ± 5 years. Young persons with diabetes had greater prevalence of Agatston score > 0 than persons without diabetes (43% vs 24%; P < .0001). In addition, 12% of persons with diabetes vs 2.5% of persons without diabetes had an Agatston score ≥ 100 (P < .0001). The prevalence of calcified plaque in coronary arteries was >50% in persons with diabetes aged >35 years. After taking into account risk factors, the presence of diabetes was associated with a 4-fold higher odds of an Agatston score ≥ 100 (odds ratio, 4.19; 95% CI, 2.29-7.65; P < .0001). CONCLUSION Our study found that 43% of young patients with diabetes have detectable coronary atherosclerosis. Given the known clinical implications of calcified plaque in coronary arteries, future studies are needed to evaluate interventions in persons aged <40 years who exhibit subclinical atherosclerosis to reduce future cardiovascular disease events in this vulnerable population.
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Affiliation(s)
- Nikhil Daga
- Department of Medicine, Los Angeles Biomedical Research Institute at Harbor University of California, Los Angeles, 1124 West Carson Street, Torrance, CA 90502
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