Natural History of Diabetic Coronary Atherosclerosis

Study Questions:

What is the rate and what are the predictors of coronary plaque progression in patients with diabetes mellitus (DM)?


The authors reported data from 1,602 patients who underwent serial coronary computed tomography angiography (CCTA) over a period of ≥24 months and were enrolled in the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. The incidence and predictors of plaque progression by serial CCTA were evaluated between patients with and without DM. Plaque progression was defined as any increase in plaque volume at follow-up compared with plaque volume at baseline.


Plaque progression was more common in diabetics than nondiabetics (85% vs. 76%, p = 0.006). DM was an independent risk factor for plaque progression (odds ratio [OR], 1.526; 95% confidence interval [CI], 1.100-2.118; p = 0.011). In propensity-matched analysis, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (-7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM.


DM is associated with greater plaque progression in patients with known coronary artery disease.


DM is a major risk factor for coronary artery disease, and nearly 40% of patients undergoing coronary revascularization in contemporary practice have DM. Multiple studies have demonstrated worse cardiac outcomes in patients who have DM. This study demonstrates very high rates of plaque progression (both in the presence and absence of DM) in this relatively stable patient population, and invokes the need for more aggressive preventive measures.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Nuclear Imaging

Keywords: Angiography, Atherosclerosis, Coronary Artery Disease, Diabetes Mellitus, Diagnostic Imaging, Myocardial Revascularization, Plaque, Atherosclerotic, Primary Prevention, Risk Factors, Tomography, X-Ray Computed, Vascular Diseases

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