Increased high-risk plaque burden in type 2 diabetes: a 10-year follow-up study

Using serial coronary CT angiography (CCTA) imaging, we aimed to characterize baseline coronary plaque characteristics and quantify 10-year coronary plaque progression, including high-risk and low-density plaque presence, in patients with and without type 2 diabetes.

A total of 299 patients underwent CCTA with a median scan interval of 10.2 [IQR 8.7-11.2] years. Patients who underwent coronary artery bypass grafting and vessels revascularized by percutaneous coronary intervention were excluded (n = 32). Scans were analyzed using atherosclerosis imaging-quantitative CCTA analysis (AI-QCT; Cleerly Inc.). Associations between diabetic status, baseline and follow-up plaque burden and characteristics were evaluated using multivariable regression adjusted for cardiovascular risk factors, statin use, baseline plaque volumes, and scanner settings.

In total, 267 patients were included (mean age 57 ± 7 years; 43% were women), 44 (16.5%) had type 2 diabetes (HbA1c 56 ± 14 mmol/mol). At baseline, patients with diabetes had a higher percent atheroma volume (PAV) compared to non-diabetic individuals (5.1% [1.7, 10.9] versus 2.2% [0.5, 5.8]). Adjusted for cardiovascular risk factors, patients with diabetes had a higher plaque burden at both baseline and follow-up. After adjustment for cardiovascular risk factors and baseline plaque volumes, individuals with diabetes had a more than threefold higher rate of plaque progression. After 10 years of follow-up, patients with diabetes had a higher prevalence of both high-risk plaque (OR 2.75; 95% CI 1.38-5.48; p = 0.004) and low-density plaque (OR 2.88; 95% CI 1.45-5.70; p = 0.002).

Patients with diabetes had a more than threefold higher rate of coronary plaque progression and an increased development of high-risk plaque.