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Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study

 Ung Kim  ;  Jonathon A. Leipsic  ;  Stephanie L. Sellers  ;  Michael Shao  ;  Philipp Blanke  ;  Martin Hadamitzky  ;  Yong-Jin Kim  ;  Edoardo Conte  ;  Daniele Andreini  ;  Gianluca Pontone  ;  Matthew J. Budoff  ;  Ilan Gottlieb  ;  Byoung Kwon Lee  ;  Eun Ju Chun  ;  j, Filippo Cademartiri  ;  Erica Maffei  ;  Hugo Marques  ;  Sanghoon Shin  ;  Jung Hyun Choi  ;  Renu Virmani  ;  Habib Samady  ;  Peter H. Stone  ;  Daniel S. Berman  ;  Jagat Narula  ;  Leslee J. Shaw  ;  Jeroen J. Bax  ;  James K. Min  ;  Hyuk-Jae Chang 
 JACC-CARDIOVASCULAR IMAGING, Vol.11(10) : 1461-1471, 2018 
Journal Title
Issue Date
computed tomography ; coronary artery disease ; diabetes mellitus ; plaque ; progression
OBJECTIVES: This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM).

BACKGROUND: The natural history of coronary PP in patients with DM is not well established.

METHODS: A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0.

RESULTS: DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (-7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM.

CONCLUSIONS: People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Byoung Kwon(이병권) ORCID logo https://orcid.org/0000-0001-9259-2776
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
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