Diabetes Metab J.  2020 Jun;44(3):470-479. 10.4093/dmj.2019.0073.

Impact of Diabetes Control on Subclinical Atherosclerosis: Analysis from Coronary Computed Tomographic Angiography Registry

• Park GM
• Lee CH
• Lee SW
• Yun SC
• Kim YH
• Kim YG
• Won KB
• Ann SH
• Kim SJ
• Yang DH
• Kang JW
• Lim TH
• Koh EH
• Lee WJ
• Kim MS
• Park JY
• Kim HK
• Choe J
• Lee SG

• KMID: 2513004
• DOI: http://doi.org/10.4093/dmj.2019.0073

Abstract

There are limited data on the impact of diabetes control on the risk of subclinical coronary atherosclerosis.

We analyzed 6,434 consecutive asymptomatic individuals without previous history of coronary artery disease who underwent coronary computed tomographic angiography (CCTA) (mean age, 53.7±7.6 years and 4,694 men [73.0%]). The degree and extent of subclinical coronary atherosclerosis were assessed by CCTA, and ≥50% diameter stenosis was defined as significant. A cardiac event was defined as a composite of all-cause death, myocardial infarction, unstable angina, or coronary revascularization. Study participants were categorized as normal (n=5,319), controlled diabetes (glycosylated hemoglobin [HbA1c] <7%, n=747), or uncontrolled diabetes (HbA1c ≥7%, n=368), respectively.

Compared with normal individuals, there were no statistically significant differences in the risk of for any atherosclerotic plaque (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.98 to 1.38; P=0.086) and significant coronary artery stenosis (OR, 1.08; 95% CI, 0.82 to 1.42; P=0.583) in controlled diabetic individuals. In contrast, uncontrolled diabetic individuals had consistently higher risks of any atherosclerotic plaque (OR, 2.16; 95% CI, 1.70 to 2.75; P<0.001) and significant coronary artery stenosis (OR, 3.34; 95% CI, 2.52 to 4.43; P<0.001) than normal individuals. During a follow-up of median 5.4 years, there was no significant difference in cardiac events between normal and controlled diabetic individuals (P=0.365). However, uncontrolled diabetes was associated with an increased risk of cardiac events compared with normal individuals (P<0.001) and controlled diabetic individuals (P=0.023).

Asymptomatic uncontrolled diabetes was associated with significant subclinical coronary atherosclerosis with subsequent high risk for cardiac events.

Keyword

Atherosclerosis; Coronary artery disease; Diabetes complications; Diabetes mellitus

Figure

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  Fig. 1 Kaplan-Meier event-free survival curves of (A) 6-year cardiac events and (B) 6-year composite outcomes of all-cause death, myocardial infarction and unstable angina according to the diabetes control. The numbers in each figure represent the 6-year event-free survival rates.

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