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Coronary atherosclerotic burden vs. coronary vascular function in diabetic and nondiabetic patients with normal
Roberta Assante1, Wanda Acampa1,2, Emilia Zampella1
1Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
Insights
Diabetic patients have similar coronary artery calcium scores to others after risk factor matching, but still show impaired vascular function. This suggests diabetes impacts coronary vascular function independently of atherosclerotic burden.
Area of Science:
- Cardiovascular Medicine
- Diabetology
- Medical Imaging
Background:
- Diabetes mellitus is a significant risk factor for cardiovascular disease.
- Coronary artery calcification (CAC) is a marker of atherosclerotic burden.
- Coronary vascular function, assessed by coronary flow reserve (CFR), is crucial for myocardial health.
Purpose of the Study:
- To investigate the relationship between coronary atherosclerotic burden (CAC) and vascular function (CFR) in diabetic versus nondiabetic patients.
- To determine if differences in CAC and CFR persist after accounting for clinical variables and risk factors using propensity score matching.
Main Methods:
- A cohort of 672 patients without overt coronary artery disease underwent stress 82Rb PET/CT imaging.
- Propensity score matching was used to balance baseline characteristics between diabetic and nondiabetic patients.
- Patients were stratified by coronary artery calcium (CAC) score quartiles to analyze trends in coronary flow reserve (CFR).
Main Results:
- Before matching, diabetic patients had higher CAC scores and lower CFR than nondiabetic patients.
- After propensity score matching, CAC scores were comparable, but diabetic patients still exhibited significantly lower CFR.
- A significant inverse relationship was observed between CAC score and CFR in both diabetic and nondiabetic patients, with diabetes independently associated with reduced CFR.
Conclusions:
- While diabetic patients initially present with higher coronary atherosclerotic burden, this difference is mitigated by matching for clinical risk factors.
- Diabetic patients demonstrate impaired coronary vascular function (lower CFR) independent of their coronary atherosclerotic burden.
- Coronary atherosclerotic burden and vascular function represent distinct pathophysiological entities in the context of diabetes.
Purpose:
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 stress 82Rb 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).
Conclusion:
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.
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