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Comparative Study
. 2022 Jan 4;21(1):1.
doi: 10.1186/s12933-021-01438-9.

The additive effect of essential hypertension on coronary artery plaques in type 2 diabetes mellitus patients: a coronary computed tomography angiography study

Yu Jiang #  1 , Yuan Li #  1 , Ke Shi  1 , Jin Wang  1 , Wen-Lei Qian  1 , Wei-Feng Yan  1 , Tong Pang  1 , Zhi-Gang Yang  2
Affiliations
Comparative Study

The additive effect of essential hypertension on coronary artery plaques in type 2 diabetes mellitus patients: a coronary computed tomography angiography study

Yu Jiang et al. Cardiovasc Diabetol. .

Abstract

Background: The effect of comorbid hypertension and type 2 diabetes mellitus (T2DM) on coronary artery plaques examined by coronary computed tomography angiography (CCTA) is not fully understood. We aimed to comprehensively assess whether comorbid hypertension and T2DM influence coronary artery plaques using CCTA.

Materials and methods: A total of 1100 T2DM patients, namely, 277 normotensive [T2DM(HTN-)] and 823 hypertensive [T2DM(HTN +)] individuals, and 1048 normotensive patients without T2DM (control group) who had coronary plaques detected on CCTA were retrospectively enrolled. Plaque type, coronary stenosis, diseased vessels, the segment involvement score (SIS) and the segment stenosis score (SSS) based on CCTA data were evaluated and compared among the groups.

Results: Compared with patients in the control group, the patients in the T2DM(HTN-) and T2DM(HTN +) groups had more partially calcified plaques, noncalcified plaques, segments with obstructive stenosis, and diseased vessels, and a higher SIS and SSS (all P values < 0.001). Compared with the control group, T2DM(HTN +) patients had increased odds of having any calcified and any noncalcified plaque [odds ratio (OR) = 1.669 and 1.278, respectively; both P values < 0.001]; both the T2DM(HTN-) and T2DM(HTN +) groups had increased odds of having any partially calcified plaque (OR = 1.514 and 2.323; P = 0.005 and P < 0.001, respectively), obstructive coronary artery disease (CAD) (OR = 1.629 and 1.992; P = 0.001 and P < 0.001, respectively), multivessel disease (OR = 1.892 and 3.372; both P-values < 0.001), an SIS > 3 (OR = 2.233 and 3.769; both P values < 0.001) and an SSS > 5 (OR = 2.057 and 3.580; both P values < 0.001). Compared to T2DM(HTN-) patients, T2DM(HTN +) patients had an increased risk of any partially calcified plaque (OR = 1.561; P = 0.005), multivessel disease (OR = 1.867; P < 0.001), an SIS > 3 (OR = 1.647; P = 0.001) and an SSS > 5 (OR = 1.625; P = 0.001).

Conclusion: T2DM is related to the presence of partially calcified plaques, obstructive CAD, and more extensive coronary artery plaques. Comorbid hypertension and diabetes further increase the risk of partially calcified plaques, and more extensive coronary artery plaques.

Keywords: Coronary artery disease; Coronary artery plaque; Coronary computed tomography angiography; Diabetes; Hypertension.

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Conflict of interest statement

The authors declare that there are no conflicts of interest.

Figures

Fig. 1
Fig. 1
Representative CCTA images of different types of coronary artery plaques. A Calcified plaque, B partially calcified plaque and C noncalcified plaque
Fig. 2
Fig. 2
Coronary artery segments: 1 proximal segment of the right coronary artery (RCA); 2 middle segment of the RCA; 3 distal segment of the RCA; 4 right posterior descending artery; 5 left main coronary artery; 6 proximal segment of the left anterior descending artery (LAD); 7 middle segment of the LAD; 8 distal segment of the LAD; 9 first diagonal branch; 10 s diagonal branch; 11 proximal segment of the left circumflex (LCX); 12 first obtuse marginal branch; 13 distal segment of the LCX; 14 s obtuse marginal branch; 15 left posterior descending artery; 16 right posterolateral artery; 17 ramus intermedius branch; 18 left posterolateral branch
Fig. 3
Fig. 3
Coronary plaque burden, stenosis and extent of coronary artery plaques detected by coronary computed tomography angiography. The mean value (A) and proportion of any presence (B) of different plaque types; the mean value of obstructive and nonobstructive coronary artery disease (CAD) (C); the proportion of any presence of obstructive CAD, multivessel disease, segment involvement score (SIS) > 3 and segment stenosis score (SSS)  > 5 (D); the mean value of diseased vessels, SIS and SSS (E)
Fig. 4
Fig. 4
Multivessel disease in a 69-year-old female with type 2 diabetes mellitus and hypertension. Volume rendering image (A) and maximum intensity projection (B) show the unsmooth edge of coronary arteries with scattered plaques, and curvature plane reconstruction images (C–E) show the diffuse partially calcified plaques distributed in the coronary arteries
See this image and copyright information in PMC

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