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Glycemic control is independently associated with rapid progression of coronary atherosclerosis in the absence of a baseline coronary plaque burden: a retrospective case-control study from the PARADIGM registry

 Ki-Bum Won  ;  Byoung Kwon Lee  ;  Fay Y Lin  ;  Martin Hadamitzky  ;  Yong-Jin Kim  ;  Ji Min Sung  ;  Edoardo Conte  ;  Daniele Andreini  ;  Gianluca Pontone  ;  Matthew J Budoff  ;  Ilan Gottlieb  ;  Eun Ju Chun  ;  Filippo Cademartiri  ;  Erica Maffei  ;  Hugo Marques  ;  Pedro de Araújo Gonçalves  ;  Jonathon A Leipsic  ;  Sang-Eun Lee  ;  Sanghoon Shin  ;  Jung Hyun Choi  ;  Renu Virmani  ;  Habib Samady  ;  Kavitha Chinnaiyan  ;  Daniel S Berman  ;  Jagat Narula  ;  Leslee J Shaw  ;  Jeroen J Bax  ;  James K Min  ;  Hyuk-Jae Chang 
 CARDIOVASCULAR DIABETOLOGY, Vol.21(1) : 239, 2022-11 
Journal Title
Issue Date
Aged ; Case-Control Studies ; Computed Tomography Angiography / methods ; Coronary Angiography / methods ; Coronary Artery Disease* / diagnostic imaging ; Coronary Vessels / diagnostic imaging ; Disease Progression ; Female ; Glycated Hemoglobin ; Glycemic Control ; Humans ; Male ; Middle Aged ; Plaque, Atherosclerotic* ; Predictive Value of Tests ; Prospective Studies ; Registries ; Retrospective Studies
Coronary artery disease ; Coronary computed tomography angiography ; Hemoglobin A1c ; Progression
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.
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1. College of Medicine (의과대학) > Research Institute (부설연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Sung, Ji Min(성지민)
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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