Identification of Risk Factors for Coronary Artery Disease in Asymptomatic Patients with Type 2 Diabetes Mellitus
Kazuhisa Takamura1, Shinichiro Fujimoto1, Tomoya Mita2
1Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan.
Insights
Current smoking, high Agatston scores, and insulin treatment predict coronary artery disease (CAD) risk in asymptomatic type 2 diabetes patients. Other non-invasive tests were not independent predictors of CAD risk.
Area of Science:
- Cardiology
- Diabetology
- Radiology
Background:
- Patients with diabetes mellitus (DM) face elevated risks for coronary artery disease (CAD).
- Identifying high-risk individuals among asymptomatic type 2 DM patients is crucial for early intervention.
- Coronary computed tomographic angiography (CCTA) aids in assessing CAD risk.
Purpose of the Study:
- To identify predictive factors for coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes.
- To evaluate the utility of various non-invasive examinations in predicting CAD risk in this population.
Main Methods:
- A prospective study involving 161 asymptomatic type 2 DM patients without known CAD.
- Coronary computed tomographic angiography (CCTA) was performed.
- Evaluated conventional risk factors, intima-media thickness, fat areas, stress ECG, and Agatston score.
Main Results:
- Current smoking and an Agatston score ≥100 were independent predictors of obstructive CAD.
- Current smoking independently predicted CT-verified high-risk plaques (CT-HRP).
- Insulin treatment was the sole predictor associated with optimal revascularization within 90 days.
Conclusions:
- Current smoking, Agatston score ≥100, and insulin treatment are key predictors of high CAD risk in asymptomatic type 2 DM patients.
- Non-invasive examinations, excluding the Agatston score, did not independently predict high CAD risk.
- These findings aid in stratifying CAD risk in diabetic patients.
Background:
Patients with diabetes mellitus (DM) are a high-risk group for coronary artery disease (CAD). In the present study, we investigated predictive factors to identify patients at high risk of CAD among asymptomatic patients with type 2 DM based on coronary computed tomographic angiography (CCTA) findings.
Methods:
A single-center prospective study was performed on 452 consecutive patients with type 2 DM who were provided with a weekly hospital-based diabetes education program between 3 October 2015, and 31 March 2020. A total of 161 consecutive asymptomatic patients (male/female: 111/50, age: 57.3 ± 9.3 years) with type 2 DM without any known CAD underwent CCTA. Based on conventional coronary risk factors and non-invasive examination, i.e., measurement of intima-media thickness, subcutaneous and visceral fat area, a stress electrocardiogram test, and the Agatston score, patients with obstructive CAD, CT-verified high-risk plaques (CT-HRP), and optimal revascularization within 90 days were evaluated.
Results:
Current smoking (OR, 4.069; 95% C.I., 1.578-10.493, p = 0.0037) and the Agatston score ≥100 (OR, 18.034; 95% C.I., 6.337-51.324, p = 0.0001) were independent predictive factors for obstructive CAD, while current smoking (OR, 5.013; 95% C.I., 1.683-14.931, p = 0.0038) was an independent predictive factor for CT-HRP. Furthermore, insulin treatment (OR, 5.677; 95% C.I., 1.223-26.349, p = 0.0266) was the only predictive factor that correlated with optimal revascularization within 90 days.
Conclusions:
In asymptomatic patients with type 2 DM, current smoking, an Agatston score ≥100, and insulin treatment were independent predictive factors of patients being at high-risk for CAD. However, non-invasive examinations except for Agatston score were not independent predictors of patients being at high risk of CAD.
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