Journal of Clinical Medicine (Feb 2022)

Identification of Risk Factors for Coronary Artery Disease in Asymptomatic Patients with Type 2 Diabetes Mellitus

  • Kazuhisa Takamura,
  • Shinichiro Fujimoto,
  • Tomoya Mita,
  • Yuko Okano Kawaguchi,
  • Mika Kurita,
  • Satoshi Kadowaki,
  • Yuki Kamo,
  • Chihiro Aoshima,
  • Yui Okada Nozaki,
  • Daigo Takahashi,
  • Ayako Kudo,
  • Makoto Hiki,
  • Nobuo Tomizawa,
  • Fuki Ikeda,
  • Hiroaki Satoh,
  • Hirotaka Watada,
  • Tohru Minamino

DOI
https://doi.org/10.3390/jcm11051226
Journal volume & issue
Vol. 11, no. 5
p. 1226

Abstract

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Background: Patients with diabetes mellitus (DM) are a high-risk group for coronary artery disease (CAD). In the present study, we investigated predictive factors to identify patients at high risk of CAD among asymptomatic patients with type 2 DM based on coronary computed tomographic angiography (CCTA) findings. Methods: A single-center prospective study was performed on 452 consecutive patients with type 2 DM who were provided with a weekly hospital-based diabetes education program between 3 October 2015, and 31 March 2020. A total of 161 consecutive asymptomatic patients (male/female: 111/50, age: 57.3 ± 9.3 years) with type 2 DM without any known CAD underwent CCTA. Based on conventional coronary risk factors and non-invasive examination, i.e., measurement of intima-media thickness, subcutaneous and visceral fat area, a stress electrocardiogram test, and the Agatston score, patients with obstructive CAD, CT-verified high-risk plaques (CT-HRP), and optimal revascularization within 90 days were evaluated. Results: Current smoking (OR, 4.069; 95% C.I., 1.578–10.493, p = 0.0037) and the Agatston score ≥100 (OR, 18.034; 95% C.I., 6.337–51.324, p = 0.0001) were independent predictive factors for obstructive CAD, while current smoking (OR, 5.013; 95% C.I., 1.683–14.931, p = 0.0038) was an independent predictive factor for CT-HRP. Furthermore, insulin treatment (OR, 5.677; 95% C.I., 1.223–26.349, p = 0.0266) was the only predictive factor that correlated with optimal revascularization within 90 days. Conclusions: In asymptomatic patients with type 2 DM, current smoking, an Agatston score ≥100, and insulin treatment were independent predictive factors of patients being at high-risk for CAD. However, non-invasive examinations except for Agatston score were not independent predictors of patients being at high risk of CAD.

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