Is diabetes mellitus a coronary artery equivalent? Insights from coronary CT angiography?

• Published in: Journal Of The Saudi Heart Association Vol. 24; no. 4; p. 277
• Main Authors: AL-Mallah, Mouaz, Alsaileek, Ahmad
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01-10-2012
• ISSN: 1016-7315; 2212-5043
• DOI: 10.1016/j.jsha.2012.06.207

The prevalence of diabetes mellitus (DM) in Saudia Arabia has increased exponentially over the past years. The current guidelines recommend that diabetics should be considered as coronary artery disease (CAD) equivalent.
The aim of this study is to determine the prevalence of CAD and atherosclerosis in asymptomatic diabetic patients.
We prospectively included 102 patients with Type II diabetes mellitus who have no prior history or symptoms of coronary artery disease. All patients underwent coronary CT Angiography (CCTA) which were interpreted on a per segment and vessel basis.
On the coronary CT Angiography, a total of 25, 59 and 18 patients had normal coronaries, non-obstructive and obstructive CAD (defined as >50% luminal stenosis) respectively. Patients with obstructive CAD were older, more often males (89% vs. 42%, p<0.001). There were no major differences in other risk factors and or baseline medications. Most patients had single vessel disease (12/18, 67%), and only 6 patients (33%) had evidence of multi-vessel CAD. After adjusting for METS, Framingham risk score and abnormal stress test, calcium score (OR 1.005 per 1 point increase in calcium score, 95% CI is 1.003–1.007, p<0.0001) was the only independent predictors of obstructive CAD.
The main findings of this analysis are that nearly 25% of diabetics have normal coronaries and 18% of diabetics have obstructive CAD. The majority of diabetic patients have evidence of atherosclerosis, but not obstructive CAD.