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Publications

Journal Article Observational Study Multicenter Study Epublish

PubMed: 42850638 DOI: 10.1186/s12933-026-03355-1

Rapid progression of coronary atherosclerosis across glycemic status: a serial coronary computed tomography angiography study from the PARADIGM registry.

Cardiovasc Diabetol 25(1)

Authors: Ki-Bum Won, Byoung Kwon Lee, Martin Hadamitzky, Yong-Jin Kim, Ji Min Sung, Edoardo Conte, Gianluca Pontone, Daniele Andreini, 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, Habib Samady, Kavitha Chinnaiyan, Jagat Narula, Leslee J Shaw, Jeroen J Bax, James K Min, Hyuk-Jae Chang

Affiliations

  • Department of Cardiology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, South Korea.
  • CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea.
  • Department of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • Department of Cardiovascular Radiology and Nuclear Medicine, TUM University Hospital, German Heart Center, Munich, Germany.
  • Department of Cardiology, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
  • Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
  • Department of Clinical and Imaging Cardiology, Galeazzi-Sant'Ambrogio Hospital, Milan, Italy.
  • Centro Cardiologico Monzino IRCCS, Milan, Italy.
  • Department of Biomedical, Dental and Surgical Sciences, University of Milan, Milan, Italy.
  • Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
  • Department of Medicine, Lundquist Institute at Harbor-UCLA, Torrance, CA, USA.
  • Fonte Imagem Medicina Diagnostica, Rio de Janeiro, Brazil.
  • Seoul National University Bundang Hospital, Seongnam, South Korea.
  • Department of Radiology, IRCCS SYNLAB SDN, Naples, Italy.
  • Unit of Cardiovascular Imaging, UNICA, Hospital da Luz, Lisbon, Portugal.
  • Comprehensive Health Research Center, LA-REAL, NOVA Medical School, Lisbon, Portugal.
  • Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada.
  • Department of Cardiology, College of Medicine, Ewha Womans University, Seoul, South Korea.
  • Department of Cardiology, Pusan University Hospital, Busan, South Korea.
  • Georgia Heart Institute, Northeast Georgia Health System, Gainesville, GA, USA.
  • Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA.
  • University of Texas Health Houston, Houston, TX, USA.
  • Icahn School of Medicine at Mount Sinai, New York, NY, USA.
  • Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
  • Cleerly, Inc, New York, NY, USA.
  • CONNECT-AI Research Center, Yonsei University College of Medicine, Seoul, South Korea.
  • Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
  • Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.

Abstract

BACKGROUND

Rapid progression of coronary atherosclerosis is associated with an increased risk of future adverse cardiovascular events. However, evidence regarding the association between glycemic status and rapid plaque progression (RPP) in the major epicardial coronary arteries remains limited.

METHODS

A total of 1296 subjects (mean age, 61 ± 9 years; 56.9% men) from the PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging) registry who underwent serial coronary computed tomography angiography and had available glycemic data were included. The median inter-scan interval was 3.2 (interquartile range, 2.6-4.4) years. Participants were classified according to glycemic status as having normal glycemic status, prediabetes, or diabetes. Percent atheroma volume (PAV) was calculated as plaque volume divided by vessel volume and multiplied by 100. RPP was defined as an increase in PAV of ≥ 1.0%/year.

RESULTS

Annual changes in PAV (%/year) differed significantly across glycemic groups (normal glycemic status, 0.30 [0.00-0.98]; prediabetes, 0.35 [0.04-0.98]; diabetes, 0.65 [0.19-1.54]; overall P < 0.001). Similarly, the incidence of RPP differed significantly across glycemic groups (normal glycemic status, 25.6%; prediabetes, 25.2%; diabetes, 38.5%; overall P < 0.001). In multivariable logistic regression analyses adjusting for clinical risk factors and baseline plaque burden, diabetes was independently associated with higher odds of RPP compared with normal glycemic status, whereas prediabetes was not. Among participants without diabetes at baseline, RPP was more frequent in those who developed new-onset diabetes than in those who did not (36.1% vs. 24.2%; P = 0.039).

CONCLUSIONS

Diabetes, but not prediabetes, was independently associated with rapid progression of coronary atherosclerosis. Furthermore, the higher incidence of RPP among participants who developed new-onset diabetes suggests that the development of diabetes may represent an important threshold for accelerated coronary plaque progression.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT02803411).

MeSH

Diabetes Mellitus, Registries, Incidence, Tomography, Angiography, Prediabetic State, Atherosclerosis, Computed Tomography Angiography