Predictors of coronary artery subclinical atherosclerotic plaques in patients with newly diagnosed type 2 diabetes mellitus
Authors: Bakalli A U R O R A , Hyseni V , Gjikolli B , Krasniqi X , Elezi S 
Published: June 2024

Abstract

Introduction
Diabetes mellitus (DM) is a major risk factor for cardiovascular disease that leads to severe complications, which usually appear after long-standing DM. Yet, newly diagnosed type 2 diabetes mellitus (NDT2DM) could also be linked to cardiac complications, albeit this aspect has been less extensively investigated. The computed tomography calcium score (CTCS) in the coronary arteries (CA) has become a widely available, accurate, and dependable tool for determining the risk of major cardiovascular events, particularly in asymptomatic individuals.

Purpose
The objective of this study was to determine the predictors for occurrence of subclinical atherosclerotic plaques in CA, detected by Computed Tomography (CT), in patients with NDT2DM.

Methods
In this prospective cross-sectional study 101 patients with NDT2DM, according to the criteria of the American Diabetes Association, were included. CTCS was performed on all patients by 64-slice cardiac CT and the Agatston method was used. Patients were categorized into five groups based on their calcium levels (0, 0-10, 11-100, 101-400 and &gt;400), and all obtained parameters were compared across these groups. Exclusion criteria were: stable angina pectoris, acute coronary disease, severe anemia, patients with history of stroke, moderate/severe renal insufficiency, liver insufficiency, claustrophobic patients, and pregnant women.

Results
Of the 101 asymptomatic patients with NDT2DM, 53 (52.5%) were males, with mean age of 54.4 ± 11.6 years and mean duration of DM of 2.8 ± 5.3 months. In table 1 the differences between the 5 groups regarding socio-demographic and general parameters are depicted. Statistical significance is shown for gender, age, arterial hypertension, dyslipidemia and waist circumference. With Spearman's correlation, we obtained a significant correlation between the CTCS and these parameters: arterial hypertension (r=0.282, P=0.004), dyslipidemia (r=0.230, P=0.020), systolic arterial pressure (r=0.281, P=0.004) and diastolic arterial pressure (r=0.232, P=0.019). Whereas with multiple regression analysis, we evaluated the impact of the general data on the CTCS values. In the model with 13 parameters, we found that all of them together had a 16.6% impact on the CTCS, but without a synergistic impact (P=0.210). Whereas, weight (P=0.04) and systolic blood pressure (P=0.033) had a significant impact (table 2).

Conclusions
Among patients with NDT2DM, those who are male, older, and have concurrent arterial hypertension and dyslipidemia, along with a larger waist circumference, tend to exhibit a greater burden of CA calcium. On the other hand, independent predictors for the development of CA atherosclerotic plaques in patients with NDT2DM include elevated body weight and systolic arterial pressure. Hence, in this subset of patients with NDT2DM, meticulous attention is warranted not only for glycemic control but also for the early prevention of cardiovascular complications. Comparison between the five groups