TY - JOUR
T1 - Glycemic control is independently associated with rapid progression of coronary atherosclerosis in the absence of a baseline coronary plaque burden
T2 - a retrospective case–control study from the PARADIGM registry
AU - Won, Ki Bum
AU - Lee, Byoung Kwon
AU - Lin, Fay Y.
AU - Hadamitzky, Martin
AU - Kim, Yong Jin
AU - Sung, Ji Min
AU - Conte, Edoardo
AU - Andreini, Daniele
AU - Pontone, Gianluca
AU - Budoff, Matthew J.
AU - Gottlieb, Ilan
AU - Chun, Eun Ju
AU - Cademartiri, Filippo
AU - Maffei, Erica
AU - Marques, Hugo
AU - de Araújo Gonçalves, Pedro
AU - Leipsic, Jonathon A.
AU - Lee, Sang Eun
AU - Shin, Sanghoon
AU - Choi, Jung Hyun
AU - Virmani, Renu
AU - Samady, Habib
AU - Chinnaiyan, Kavitha
AU - Berman, Daniel S.
AU - Narula, Jagat
AU - Shaw, Leslee J.
AU - Bax, Jeroen J.
AU - Min, James K.
AU - Chang, Hyuk Jae
N1 - Funding Information:
Dr. Jonathon A. Leipsic serves as a consultant and has stock options in HeartFlow and Circle Cardiovascular Imaging; he also receives grant support from GE Healthcare and speaking fees from Philips. Dr. Habib Samady has an equity interest in Covanos. Dr. Daniel Berman receives software royalties from Cedars-Sinai Medical Center. Dr. James K. Min receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare. Dr. Min serves on the scientific advisory board of Arineta and GE Healthcare and has an equity interest in Cleerly. All other authors declare that they have no competing interests.
Funding Information:
This work was supported by the Korea Medical Device Development Fund grant funded by the Korean government (Ministry of Science and ICT; Ministry of Trade, Industry and Energy; Ministry of Health & Welfare, Republic of Korea; and Ministry of Food and Drug Safety; Project Number: 202016B02).
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - Background: The baseline coronary plaque burden is the most important factor for rapid plaque progression (RPP) in the coronary artery. However, data on the independent predictors of RPP in the absence of a baseline coronary plaque burden are limited. Thus, this study aimed to investigate the predictors for RPP in patients without coronary plaques on baseline coronary computed tomography angiography (CCTA) images. Methods: A total of 402 patients (mean age: 57.6 ± 10.0 years, 49.3% men) without coronary plaques at baseline who underwent serial coronary CCTA were identified from the Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry and included in this retrospective study. RPP was defined as an annual change of ≥ 1.0%/year in the percentage atheroma volume (PAV). Results: During a median inter-scan period of 3.6 years (interquartile range: 2.7–5.0 years), newly developed coronary plaques and RPP were observed in 35.6% and 4.2% of the patients, respectively. The baseline traditional risk factors, i.e., advanced age (≥ 60 years), male sex, hypertension, diabetes mellitus, hyperlipidemia, obesity, and current smoking status, were not significantly associated with the risk of RPP. Multivariate linear regression analysis showed that the serum hemoglobin A1c level (per 1% increase) measured at follow-up CCTA was independently associated with the annual change in the PAV (β: 0.098, 95% confidence interval [CI]: 0.048–0.149; P < 0.001). The multiple logistic regression models showed that the serum hemoglobin A1c level had an independent and positive association with the risk of RPP. The optimal predictive cut-off value of the hemoglobin A1c level for RPP was 7.05% (sensitivity: 80.0%, specificity: 86.7%; area under curve: 0.816 [95% CI: 0.574–0.999]; P = 0.017). Conclusion: In this retrospective case–control study, the glycemic control status was strongly associated with the risk of RPP in patients without a baseline coronary plaque burden. This suggests that regular monitoring of the glycemic control status might be helpful for preventing the rapid progression of coronary atherosclerosis irrespective of the baseline risk factors. Further randomized investigations are necessary to confirm the results of our study. Trial registration: ClinicalTrials.gov NCT02803411.
AB - Background: The baseline coronary plaque burden is the most important factor for rapid plaque progression (RPP) in the coronary artery. However, data on the independent predictors of RPP in the absence of a baseline coronary plaque burden are limited. Thus, this study aimed to investigate the predictors for RPP in patients without coronary plaques on baseline coronary computed tomography angiography (CCTA) images. Methods: A total of 402 patients (mean age: 57.6 ± 10.0 years, 49.3% men) without coronary plaques at baseline who underwent serial coronary CCTA were identified from the Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging (PARADIGM) registry and included in this retrospective study. RPP was defined as an annual change of ≥ 1.0%/year in the percentage atheroma volume (PAV). Results: During a median inter-scan period of 3.6 years (interquartile range: 2.7–5.0 years), newly developed coronary plaques and RPP were observed in 35.6% and 4.2% of the patients, respectively. The baseline traditional risk factors, i.e., advanced age (≥ 60 years), male sex, hypertension, diabetes mellitus, hyperlipidemia, obesity, and current smoking status, were not significantly associated with the risk of RPP. Multivariate linear regression analysis showed that the serum hemoglobin A1c level (per 1% increase) measured at follow-up CCTA was independently associated with the annual change in the PAV (β: 0.098, 95% confidence interval [CI]: 0.048–0.149; P < 0.001). The multiple logistic regression models showed that the serum hemoglobin A1c level had an independent and positive association with the risk of RPP. The optimal predictive cut-off value of the hemoglobin A1c level for RPP was 7.05% (sensitivity: 80.0%, specificity: 86.7%; area under curve: 0.816 [95% CI: 0.574–0.999]; P = 0.017). Conclusion: In this retrospective case–control study, the glycemic control status was strongly associated with the risk of RPP in patients without a baseline coronary plaque burden. This suggests that regular monitoring of the glycemic control status might be helpful for preventing the rapid progression of coronary atherosclerosis irrespective of the baseline risk factors. Further randomized investigations are necessary to confirm the results of our study. Trial registration: ClinicalTrials.gov NCT02803411.
KW - Coronary artery disease
KW - Coronary computed tomography angiography
KW - Hemoglobin A1c
KW - Progression
UR - http://www.scopus.com/inward/record.url?scp=85141721255&partnerID=8YFLogxK
U2 - 10.1186/s12933-022-01656-9
DO - 10.1186/s12933-022-01656-9
M3 - Article
C2 - 36371222
AN - SCOPUS:85141721255
SN - 1475-2840
VL - 21
JO - Cardiovascular Diabetology
JF - Cardiovascular Diabetology
IS - 1
M1 - 239
ER -