Diabetes and Subclinical Coronary Atherosclerosis

Abstract

It is well known that diabetic patients have a high risk of cardiovascular events, and although there has been a tremendous effort to reduce these cardiovascular risks, the incidence of cardiovascular morbidity and mortality in diabetic patients remains high. Therefore, the early detection of coronary artery disease (CAD) is necessary in those diabetic patients who are at risk of cardiovascular events. Significant medical and radiological advancements, including coronary computed tomography angiography (CCTA), mean that it is now possible to investigate the characteristics of plaques, instead of solely evaluating the calcium level of the coronary artery. Recently, several studies reported that the prevalence of subclinical coronary atherosclerosis (SCA) is higher than expected, and this could impact on CAD progression in asymptomatic diabetic patients. In addition, several reports suggest the potential benefit of using CCTA for screening for SCA in asymptomatic diabetic patients, which might dramatically decrease the incidence of cardiovascular events. For these reasons, the medical interest in SCA in diabetic patients is increasing. In this article, we sought to review the results of studies on CAD in asymptomatic diabetic patients and discuss the clinical significance and possibility of using CCTA to screen for SCA.

Keywords: Atherosclerosis; Computed tomography angiography; Coronary vessels; Diabetes mellitus.

Fig. 1. Examples of different coronary computed tomography findings. Curved multiplanar reconstructions of the (A) left anterior descending (LAD) coronary artery, (B) left circumflex coronary artery, and (C) right coronary artery of a patient with normal coronary arteries. The curved multiplanar reconstruction of the LAD shows tubular coronary artery disease with a nonobstructive and noncalcified lesion (arrow, D) in a newly diagnosed diabetic patient.

Fig. 2. Proposed algorithm for individualized coronary artery disease (CAD) screening in asymptomatic type 2 diabetes mellitus patients based on a risk-score model. Adapted from Park et al. [36]. CT, computed tomography.