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. 2023 Oct;16(10):e015314.
doi: 10.1161/CIRCIMAGING.123.015314. Epub 2023 Sep 29.

Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida

Kershaw V Patel  1 , Matthew J Budoff  2   3 , Javier Valero-Elizondo  1   4 , Shubham Lahan  1 , Shozab S Ali  5   6 , Mohamad B Taha  1 , Michael J Blaha  7 , Ron Blankstein  8 , Michael D Shapiro  9 , Ambarish Pandey  10 , Lara Arias  5 , Theodore Feldman  5   6 , Ricardo C Cury  5   6 , Miguel Cainzos-Achirica  7   11 , Svati H Shah  12 , Jack A Ziffer  5 , Jonathan Fialkow  5 , Khurram Nasir  1   4   7
Affiliations

Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida

Kershaw V Patel et al. Circ Cardiovasc Imaging. 2023 Oct.

Abstract

Background: The contemporary burden and characteristics of coronary atherosclerosis, assessed using coronary computed tomography angiography (CCTA), is unknown among asymptomatic adults with diabetes and prediabetes in the United States. The pooled cohort equations and coronary artery calcium (CAC) score stratify atherosclerotic cardiovascular disease risk, but their association with CCTA findings across glycemic categories is not well established.

Methods: Asymptomatic adults without atherosclerotic cardiovascular disease enrolled in the Miami Heart Study were included. Participants underwent CAC and CCTA testing and were classified into glycemic categories. Prevalence of coronary atherosclerosis (any plaque, noncalcified plaque, plaque with ≥1 high-risk feature, maximal stenosis ≥50%) assessed by CCTA was described across glycemic categories and further stratified by pooled cohort equations-estimated atherosclerotic cardiovascular disease risk and CAC score. Adjusted logistic regression was used to evaluate the associations between glycemic categories and coronary outcomes.

Results: Among 2352 participants (49.5% women), the prevalence of euglycemia, prediabetes, and diabetes was 63%, 30%, and 7%, respectively. Coronary plaque was more commonly present across worsening glycemic categories (euglycemia, 43%; prediabetes, 58%; diabetes, 69%), and similar pattern was observed for other coronary outcomes. In adjusted analyses, compared with euglycemia, prediabetes and diabetes were each associated with higher odds of any coronary plaque (OR, 1.30 [95% CI, 1.05-1.60] and 1.75 [1.17-2.61], respectively), noncalcified plaque (OR, 1.47 [1.19-1.81] and 1.99 [1.38-2.87], respectively), and plaque with ≥1 high-risk feature (OR, 1.65 [1.14-2.39] and 2.53 [1.48-4.33], respectively). Diabetes was associated with stenosis ≥50% (OR, 3.01 [1.79-5.08]; reference=euglycemia). Among participants with diabetes and estimated atherosclerotic cardiovascular disease risk <5%, 46% had coronary plaque and 10% had stenosis ≥50%. Among participants with diabetes and CAC=0, 30% had coronary plaque and 3% had stenosis ≥50%.

Conclusions: Among asymptomatic adults, worse glycemic status is associated with higher prevalence and extent of coronary atherosclerosis, high-risk plaque, and stenosis. In diabetes, CAC was more closely associated with CCTA findings and informative in a larger population than the pooled cohort equations.

Keywords: atherosclerosis; diabetes; glucose; prediabetic state; prevalence.

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Conflict of interest statement

Disclosures Dr Patel has received research support from the National Heart, Lung, and Blood Institute (R21HL169708); has served as a consultant to Novo Nordisk. Dr Blankstein receives research support from Amgen Inc and Novartis Inc and is a consultant to Caristo Diagnostics, Silence Therapeutics, and Roivant Sciences Inc. Dr Shapiro is on the advisory boards of Amgen, Novartis, and Novo Nordisk and is a consultant for Regeneron. Dr. Pandey has received research support from the National Institute on Aging GEMSSTAR Grant (1R03AG067960-01), the National Institute on Minority Health and Disparities (R01MD017529), and the National Institute of Heart, Lung, and Blood Institute (R21HL169708). Dr. Pandey has received grant funding (to the institution) from Applied Therapeutics, Gilead Sciences, Ultromics, Myovista, and Roche; has served as a consultant for and/or received honoraria outside of the present study as an advisor/consultant for Tricog Health Inc, Lilly USA, Rivus, Cytokinetics, Roche Diagnostics, Sarfez Therapeutics, Edwards Lifesciences, Merck, Bayer, Novo Nordisk, Alleviant, Axon Therapies, and has received nonfinancial support from Pfizer and Merck. Dr. Pandey is also a consultant for Palomarin Inc. with stocks compensation. Dr Cury declares that he is a consultant to GE Healthcare, Covera Health, and Cleerly. Dr Nasir is on the advisory board of Amgen, Novartis, Novo Nordisk, and his research is partly supported by the Jerold B. Katz Academy of Translational Research. Dr Cainzos-Achirica and Dr Nasir are part of the steering committee of the PAK-SEHAT study, which is partly funded by Getz Pharma. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.. Distribution of estimated ASCVD risk categories* and CAC score categories across glycemic strata.
*Estimated using the Pooled Cohort Equations. CAC scores presented in Agatston units. Abbreviations: ASCVD; atherosclerotic cardiovascular disease; CAC, coronary artery calcium
Figure 2.
Figure 2.. Prevalence of atherosclerotic plaque in coronary segments across glycemic categories.
Each number (circles) identifies a coronary artery segment as follows: 1, proximal RCA; 2, mid RCA; 3, distal RCA; 4, posterolateral artery; 5, posterior descending artery; 6, left main coronary artery; 7, ramus intermedius; 8, proximal LAD; 9, first diagonal; 10, mid LAD; 11, second diagonal; 12, distal LAD; 13, proximal LCX; 14, first obtuse marginal; 15, distal LCX; 16, second obtuse marginal; 17, third obtuse marginal. * The prevalence of plaque in the posterolateral artery includes the right and left posterolateral arteries. Abbreviations: LAD, left anterior descending coronary artery; LCX, left circumflex coronary artery; RCA, right coronary artery
Figure 3.
Figure 3.. Distribution of number of coronary segments with atherosclerotic plaque across glycemic categories.
Abbreviations: ASCVD; atherosclerotic cardiovascular disease; CAC, coronary artery calcium; CCTA, cardiac computed tomography angiography; CT, computed tomography
See this image and copyright information in PMC

Comment in

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