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Coronary atherosclerosis in diabetes mellitus: a population-based autopsy study
Tauqir Y Goraya1, Cynthia L Leibson, Pasquale J Palumbo
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Scottsdale, AZ, USA.
Insights
Diabetes significantly increases coronary atherosclerosis prevalence, even in individuals without diagnosed coronary artery disease (CAD). Diabetic individuals without clinical CAD show similar atherosclerosis severity to non-diabetics with diagnosed CAD.
Area of Science:
- Cardiovascular pathology
- Diabetology
- Epidemiology
Background:
- Individuals with diabetes but without clinical coronary artery disease (CAD) experience cardiovascular mortality rates comparable to non-diabetics with diagnosed CAD.
- The underlying reasons for this elevated mortality in diabetic individuals without clinical CAD remain incompletely understood.
- This study investigates the link between diabetes and coronary atherosclerosis using a comprehensive autopsy-based population in Rochester, Minnesota.
Purpose of the Study:
- To test the hypothesis that coronary atherosclerosis is more prevalent in diabetic individuals compared to non-diabetic individuals.
- To determine if diabetic individuals without clinical CAD exhibit a similar prevalence and severity of coronary atherosclerosis as non-diabetic individuals with clinical CAD.
Main Methods:
- Analysis of coronary atherosclerosis using a global coronary score and high-grade stenoses in an autopsied cohort.
- Stratification of data based on diabetes status, clinical CAD diagnosis, age, and gender.
- Utilized the Rochester Epidemiology Project for rigorous data ascertainment.
Main Results:
- Diabetes is significantly associated with a higher prevalence of coronary atherosclerosis.
- Nearly three-fourths of diabetic individuals without clinical CAD showed high-grade coronary atherosclerosis, with over half having multivessel disease.
- The protective effect of female gender against atherosclerosis was diminished in the presence of diabetes.
Conclusions:
- Findings suggest diabetes contributes mechanistically to the increased risk of clinical CAD.
- The study underscores the necessity of aggressive atherosclerosis prevention strategies for all individuals with diabetes, regardless of symptomatic CAD.
- These insights aid in understanding the excess cardiovascular risk associated with diabetes.
Objectives:
The study was conducted to test the hypothesis that the prevalence of coronary atherosclerosis is greater among diabetic than among nondiabetic individuals and is similar for diabetic individuals without clinical coronary artery disease (CAD) and nondiabetics with clinical CAD.
Background:
Persons with diabetes but without clinical CAD encounter cardiovascular mortality similar to nondiabetic individuals with clinical CAD. This excess mortality is not fully explained. We examined the association between diabetes and coronary atherosclerosis in a geographically defined autopsied population, while capitalizing on the autopsy rate and medical record linkage system available via the Rochester Epidemiology Project, which allows rigorous ascertainment of coronary atherosclerosis, clinical CAD, and diabetes.
Methods:
Using two measures, namely a global coronary score and high-grade stenoses, the prevalence of atherosclerosis was analyzed in a cohort of autopsied residents of Rochester, Minnesota, age 30 years or older at death, while stratifying on diabetes, clinical CAD diagnosis, age, and gender.
Results:
In this cohort, diabetes was associated with a higher prevalence of atherosclerosis. Among diabetic decedents without clinical CAD, almost three-fourths had high-grade coronary atherosclerosis and more than half had multivessel disease. Without diabetes, women had less atherosclerosis than men, but this female advantage was lost with diabetes. Among those without clinical CAD, diabetes was associated with a global coronary disease burden and a prevalence of high-grade atherosclerosis similar to that observed among nondiabetic subjects with clinical CAD.
Conclusions:
These findings provide mechanistic insights into the excess risk of clinical CAD among diabetic individuals, thereby supporting the need for aggressive prevention of atherosclerosis in all diabetic individuals, irrespective of clinical CAD symptoms.