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

Affiliations
  • 1Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.
  • 2Department of Cardiology, Veterans Health Service Medical Center, Seoul, Korea.
  • 3Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 4Department of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 5Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 6Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 7The Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Abstract

Background

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

Methods

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.

Results

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).

Conclusion

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

  • 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.


Cited by  1 articles

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Kyoung Jin Kim, Jimi Choi, Jae Hyun Bae, Kyeong Jin Kim, Hye Jin Yoo, Ji A Seo, Nan Hee Kim, Kyung Mook Choi, Sei Hyun Baik, Sin Gon Kim, Nam Hoon Kim
Diabetes Metab J. 2021;45(3):368-378.    doi: 10.4093/dmj.2020.0046.


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