Impact of optimal glycemic control on the progression of coronary artery calcification in asymptomatic patients with diabetes

Background: Data on the impact of optimal glycemic control (OGC) on the progression of coronary artery calcification, an important marker for future adverse cardiovascular events in individuals with diabetes are limited. Methods: We investigated 1637 asymptomatic adults with diabetes (56 ± 8 years, 88.8% men) and no history of coronary artery disease or stroke, who underwent serial coronary artery calcium (CAC) screening. The median inter-scan period was 3.0 (2.0–4.4) years. The change in CAC was compared base on OGC status. OGC was defined as a follow-up hemoglobin A1C (HbA1C) of <7.0%, and CAC progression was defined by a square root (√) transformed difference between the baseline and follow-up CAC scores (Δ √transformed CAC) of ≥2.5. Results: Despite no significant difference in the baseline CAC scores, the incidence of CAC progression was lower in the OGC group than in the non-OGC group (45.4% vs. 51.7%; p < 0.013). The two groups differed in the Δ √transformed (OGC, 3.8 ± 6.4; non-OGC, 4.7 ± 6.9; p = 0.016) and annualized Δ √transformed CAC (OGC, 1.1 ± 2.4; non-OGC, 1.4 ± 2.6; p = 0.010) scores. Subgroup analysis showed that OGC significantly reduced the risk of CAC progression in patients aged <65 years and in: smokers, and patients with a body mass index of <25 kg/m², dyslipidemia, and baseline CAC scores between 1–100 and >400. In multivariate regression analysis, OGC was independently associated with a reduced risk of CAC progression (odds ratio, 0.745, 95% confidence interval, 0.601–0.924; p = 0.007). Conclusion: OGC attenuated the progression of coronary artery calcification in asymptomatic patients with diabetes.