Impact of diabetes duration on the extent and severity of coronary atheroma burden and long-term clinical outcome in asymptomatic type 2 diabetic patients: Evaluation by coronary CT angiography

Aims: We investigated the association between diabetes duration and the extent and severity of coronary artery disease (CAD) aswell as long-term clinical outcomes using coronary computed tomography angiography (CCTA) in asymptomatic type 2 diabetic patients. Methods and results: We analysed 933 asymptomatic type 2 diabetic patients without known CAD who underwent CCTA. Patients were divided into three groups according to the duration of diabetes: <5 years, 5.10 years, and ≥10 years. Stenosis by CCTA was scored as none (0%), non-obstructive (1.49%), or obstructive (≥50%) for each coronary artery segment. For these patients, we compared the prevalence, extent, and severity of CAD, including coronary artery calcium score (CACS), atheroma burden obstructive score (ABOS), segment involvement score (SIS), and segment stenosis score (SSS). Major adverse cardiac and cerebrovascular events(MACCE), including all-cause mortality, non-fatal myocardial infarction, and stroke, within a follow-up period were also compared. Patients with longer duration of diabetes possessed higher rates of obstructive CAD(P < 0.001). Patients with longer duration of diabetes also manifested greater degree of CACS, ABOS, SIS, and SSS (P < 0.001 for all) with associated higher rate of MACCE (P = 0.025). Presence of obstructive CAD as assessed by CCTA was an independent predictor of MACCE after adjusting for confounding risk factors (hazard ratio: 1.979, confidence interval: 1.178.3-327, P = 0.010). Conclusion: In asymptomatic diabetic patients, longer diabetes duration is associated with a higher prevalence, extent, and severity of CADaswell as risk of MACCE. Moreover, greater CADburden increases the risk of MACCE independent of co-existing CAD risk factors.