Association of type 2 diabetes mellitus with coronary atherosclerotic plaque burden and morphology measured by multidetector computed tomography coronary angiography

Aims Diabetes mellitus (DM) is strongly associated with increased risk of coronary artery disease (CAD). The aim of this study was to determine differences in presence, extent and morphology of coronary atherosclerotic plaques (CAP) detected by multidetector computed tomography (MDCT) between symptomatic patients with and without diabetes. Methods The CAPs (calcified, non-calcified, mixed) were compared between patients with/without diabetes (104/257 DM; mean age 58.6 +/- 11 y; 46.3% male) who underwent dual-source 64-slice MDCT for evaluation of CAD. Severity, extent and morphology of CAPs were determined per each segment. Results Critical coronary stenosis was higher in patients with diabetes (33.7% vs 19.6%) after adjustment for all risk factors (P = 0.022). Patients with DM had a higher prevalence and extent of CAP compared to non-diabetic subjects (87.5% vs 43.8%, 4.8 +/- 3.5 vs 1.9 +/- 2.7, respectively; P < 0.001). Non-calcified and mixed CAP were more prevalent in patients with diabetes as compared to those without diabetes (2.61 +/- 2.63 vs 0.86 +/- 1.69, 0.81 +/- 1.6 vs 0.35 +/- 0.96, respectively, P<0.001). Patients with DM tended to have higher prevalence of significant 1-, 2- and 3-vessel disease (P=0.006). Conclusions Among individuals referred for the evaluation of CAD, those with DM had a higher risk of coronary stenosis and overall increased CAP burden independent from other cardiovascular risk factors shown by MDCT. Further studies are needed to evaluate the prognostic value of different plaque compositions observed in patients with diabetes.