Coronary atherosclerosis burden by coronary computed tomography in type II diabetes with preclinical non-obstructive carotid atherosclerosis and without inducible myocardial ischemia

Aims: To quantify cardiovascular risk in persons with type-2 diabetes (DM) and established carotid atherosclerosis, without inducible myocardial ischemia by stress imaging. Methods: We selected clinically healthy DM and subjects without DM (nonDM, controls) with non-obstructive carotid atherosclerosis and without significant coronary artery disease (CAD) by stress echocardiography. Coronary flow velocity reserve (CFR) was assessed during stress echocardiography. In those with negative stress imaging, coronary artery calcium (CAC) assessment by computed tomography (CT) was proposed. Outcome at 180-day follow-up was performed by visits or telephone interview. Results: Total CAC was greater in DM (n = 19) than in nonDM (n = 19, CAC: 225 +/- 158 vs 78 +/- 65 Agatston units, 156 +/- 161 vs 53 +/- 51 in the left anterior descendent artery, both p < 0.05). Coronary stenosis burden was greater in DM than in nonDM, albeit < 75% in all cases; CFR was lower in DM than nonDM (p < 0.05). Mean age was slightly higher (69 +/- 6 vs 64 +/- 12, p > 0.2), and male gender tended to be less frequent (63 vs 79%) with DM than with nonDM; all subjects showed dyslipidemia, and almost all had arterial hypertension. Based on CAC, a 10-year cardiovascular risk was 10-20% in 78% of the DM and in 28% of the non-DM, and was > 20% in 11% of the DM but in none of the nonDM. A single nonfatal myocardial infarction was recorded within 180 days from test, among DM. Conclusions: Based on CAC, in the presence of non-obstructive carotid atherosclerosis, asymptomatic DM may show significantly higher CAD burden than nonDM even in the absence of inducible myocardial ischemia. (C) 2016 Elsevier Ireland Ltd. All rights reserved.