Subclinical Vascular Impairment in Newly Diagnosed Asymptomatic Patients with Type-2 Diabetes Mellitus: Emphasis on Coronary Plaque Features

Author(s): Sine Skov MD, Lotte Grumsen MD, Gulia Faizi MD, Jeppe Gram MD, PhD, Niels Peter Rønnow Sand MD, PhD, Monija Mrgan MD, PhD

Purpose:

To assess the presence of subclinical atherosclerosis in asymptomatic patients with newly diagnosed (<1 year) type-2 diabetes mellitus (T2DM) without known cardiovascular disease (CVD) with special emphasis on coronary artery disease.

Methods:

Non-contrast cardiac CT and coronary artery calcium scoring (CAC) was performed in 115 patients. A subset of the population (77 %) underwent contrast enhanced coronary CT angiography (CTA). Advanced coronary plaque analysis was performed using a validated semi-automated program (AutoPlaque). Measurements of intima media thickness (IMT) by carotid ultrasound, arterial stiffness by pulse wave analysis (PWA), occurrence of peripheral artery disease (PAD) by ankle brachial index (ABI) and vascular leakage by albumin creatinine ratio (ACR) were performed in all patients. Thresholds for sifgns of atherosclerosis were: IMT>0.9 mm; ABI<0.9 and ACR>30 mg/g.

Results:

Patients with CAC >0 was significantly older (61 vs 52 y, p<0,05), were more frequently men (38 vs. 35, p<0,05), had higher PWA (8,9 vs 7,9 m/s, p<0,01) and IMT (0,8 vs 0,7 mm, p=0,01). LD-NCP ratio increased with higher total plaque volume (TPV) in patients with CAC (τ = 0.45, p <0.05). A high amount of LD-NCP was significantly associated with higher D-dimer (p=0,011) and higher LDL cholesterol (p=0,003). Sign of PAD and increased ACR was present in 8% of the patients of whom all had CAC>0.

Conclusion:

At the time of diagnosis of T2DM more than 60 % of asymptomatic patients present with signs of subclinical atherosclerosis. Coronary plaque composition in these patients displays features associated with an increased vulnerability.