Impact of diabetes on coronary plaque characteristics and major adverse cardiovascular events
Authors: Dvinelis E , Gimzauskaite S , Stasilo R , Kapacinskaite M , Cesnaite G , Vrublevska G , Glaveckaite S 
Published: January 2025

Abstract

Background
Cardiovascular disease (CVD) is a leading cause of global morbidity and mortality, with diabetes significantly exacerbating its progression. Characterizing coronary plaque composition and its association with cardiovascular outcomes is crucial for understanding disease pathogenesis. Understanding the influence of diabetes on these parameters can enhance our ability to manage CVD outcomes more effectively.

Purpose
We aimed to investigate the impact of diabetes on coronary plaque characteristics and its association with Major Adverse Cardiovascular Events (MACE) in a single-centre cohort.

Methods
We assessed 190 patients who underwent coronary computed tomography angiography (CCTA) for evaluation of chest pain, excluding 15 patients due to low image quality, and the remaining 175 were further evaluated. Statistical analyses included multiple regression models to examine the relationship between plaque characteristics and diabetes status, ANOVA to compare characteristics between groups, and logistic regression to calculate the odds ratio (OR) for MACE differences between diabetic and non-diabetic patients. MACE was defined as acute myocardial infarction, stroke, cardiovascular mortality, and revascularization.

Results
The study included 175 participants: 47 patients diagnosed with diabetes and 128 patients without. The mean age of the patients was 58.7 years (±11 years). A total of 270 coronary plaques were analyzed: 167 plaques from patients without diabetes and 103 plaques from patients with diabetes. The patient cohort consisted of 47.4% men. Patients without diabetes had significantly lower values compared to those with diabetes across several measures: the median (Interquartile Range - IQR) Agatston score (150.5 (55-349) vs 473.0 (179-1269), F(1, 254) = 27.909, p &lt; 0.001, B = -527.715), lesion length (mm) (5.1 (3.5-7.1) vs 6,0 (4.1-11.2), F(1, 254) = 11.613, p &lt; 0.001, B = -3.789), plaque burden (0.23 (0.16-0.32) vs 0.28 (0.20-0.38), F(1, 254) = 14.429, p &lt; 0.001, B = -0.060), plaque volume (mm³) (13.2 (6.5-24.6) vs 20.8 (9.4-47.8), F(1, 254) = 16.267, p &lt; 0.001, B = -26.315), fibrous volume (mm³) (4.6 (2.3-9.4) vs 7.7 (3.2-16.6), F(1, 254) = 21.238, p &lt; 0.001, B = -8.930), fibrous fatty volume (mm³) (0.41 (0.09-0.9) vs 0.99 (0.2-2.3), F(1, 254) = 5.236, p = 0.023, B = -0.603) and dense calcium volume (mm³) (6.2 (3.1-13.9) vs 9.3 (3.5-23.4), F (1, 254) = 12.644, p &lt; 0.001, B = -16.288). There were 16 MACEs in total, with diabetic patients showing significantly higher odds of experiencing MACE than non-diabetic patients (OR = 3.077, p = 0.035).

Conclusions
These findings suggest that diabetes is associated with more extensive and potentially more severe coronary artery disease, impacting the development of various plaque characteristics. Future research could explore larger cohorts to validate these findings and explore the underlying mechanisms linking diabetes, plaque characteristics, and cardiovascular outcomes.