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Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study.
JACC Cardiovasc Imaging. 2018 10; 11(10):1461-1471.JC

Abstract

OBJECTIVES

This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM).

BACKGROUND

The natural history of coronary PP in patients with DM is not well established.

METHODS

A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0.

RESULTS

DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (-7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM.

CONCLUSIONS

People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.

Authors+Show Affiliations

Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Yeungnam University Medical Center, Daegu, South Korea.Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada. Electronic address: jleipsic@providencehealth.bc.ca.Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Centre for Heart Lung Innovation, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada.Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany.Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany; Seoul National University Hospital, Seoul, South Korea.Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California.Department of Radiology, Casa de Saude São Jose, Rio de Janeiro, Brazil.Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.Seoul National University Bundang Hospital, South Korea.Cardiovascular Imaging Center, SDN Foundation IRCCS, Naples, Italy.Department of Radiology, Area Vasta 1/Azienda Sanitaria Unica Regionale (ASUR) Marche, Urbino, Italy.Hospital da Luz, Lisbon, Portugal.National Health Insurance Service Ilsan Hospital, Goyang, South Korea.Busan University Hospital, Busan, South Korea.Department of Pathology, CVPath Institute, Gaithersburg, Maryland.Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.Department of Imaging, Cedars-Sinai Medical Center, Cedars-Sinai Heart Institute, Los Angeles, California.Icahn School of Medicine at Mount Sinai, Mount Sinai Heart, Zena and Michael A. Wiener Cardiovascular Institute, and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, New York, New York.Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, the Netherlands.Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York.Division of Cardiology, Severance Cardiovascular Hospital, Integrative Cardiovascular Imaging Center, Yonsei University College of Medicine, Seoul, South Korea.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29778853

Citation

Kim, Ung, et al. "Natural History of Diabetic Coronary Atherosclerosis By Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study." JACC. Cardiovascular Imaging, vol. 11, no. 10, 2018, pp. 1461-1471.
Kim U, Leipsic JA, Sellers SL, et al. Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study. JACC Cardiovasc Imaging. 2018;11(10):1461-1471.
Kim, U., Leipsic, J. A., Sellers, S. L., Shao, M., Blanke, P., Hadamitzky, M., Kim, Y. J., Conte, E., Andreini, D., Pontone, G., Budoff, M. J., Gottlieb, I., Lee, B. K., Chun, E. J., Cademartiri, F., Maffei, E., Marques, H., Shin, S., Choi, J. H., ... Chang, H. J. (2018). Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study. JACC. Cardiovascular Imaging, 11(10), 1461-1471. https://doi.org/10.1016/j.jcmg.2018.04.009
Kim U, et al. Natural History of Diabetic Coronary Atherosclerosis By Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study. JACC Cardiovasc Imaging. 2018;11(10):1461-1471. PubMed PMID: 29778853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study. AU - Kim,Ung, AU - Leipsic,Jonathon A, AU - Sellers,Stephanie L, AU - Shao,Michael, AU - Blanke,Philipp, AU - Hadamitzky,Martin, AU - Kim,Yong-Jin, AU - Conte,Edoardo, AU - Andreini,Daniele, AU - Pontone,Gianluca, AU - Budoff,Matthew J, AU - Gottlieb,Ilan, AU - Lee,Byoung Kwon, AU - Chun,Eun Ju, AU - Cademartiri,Filippo, AU - Maffei,Erica, AU - Marques,Hugo, AU - Shin,Sanghoon, AU - Choi,Jung Hyun, AU - Virmani,Renu, AU - Samady,Habib, AU - Stone,Peter H, AU - Berman,Daniel S, AU - Narula,Jagat, AU - Shaw,Leslee J, AU - Bax,Jeroen J, AU - Min,James K, AU - Chang,Hyuk-Jae, Y1 - 2018/05/16/ PY - 2017/10/09/received PY - 2018/04/11/revised PY - 2018/04/12/accepted PY - 2018/5/21/pubmed PY - 2019/11/21/medline PY - 2018/5/21/entrez KW - computed tomography KW - coronary artery disease KW - diabetes mellitus KW - plaque KW - progression SP - 1461 EP - 1471 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 11 IS - 10 N2 - OBJECTIVES: This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM). BACKGROUND: The natural history of coronary PP in patients with DM is not well established. METHODS: A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0. RESULTS: DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (-7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM. CONCLUSIONS: People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/29778853/Natural_History_of_Diabetic_Coronary_Atherosclerosis_by_Quantitative_Measurement_of_Serial_Coronary_Computed_Tomographic_Angiography:_Results_of_the_PARADIGM_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(18)30356-5 DB - PRIME DP - Unbound Medicine ER -