Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study
Abstract Background Evidence from imaging studies suggests a high prevalence of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, there are no criteria for initiating screening for CAD in this population. The current study investigated whether clinical and demo...
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| Format: | Article |
| Language: | English |
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BMC
2019-04-01
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| Series: | Cardiovascular Diabetology |
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| Online Access: | http://link.springer.com/article/10.1186/s12933-019-0855-8 |
| _version_ | 1818340509136977920 |
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| author | Shreenidhi M. Venuraju Avijit Lahiri Anand Jeevarethinam Mark Cohen Daniel Darko Devaki Nair Miranda Rosenthal Roby D. Rakhit |
| author_facet | Shreenidhi M. Venuraju Avijit Lahiri Anand Jeevarethinam Mark Cohen Daniel Darko Devaki Nair Miranda Rosenthal Roby D. Rakhit |
| author_sort | Shreenidhi M. Venuraju |
| collection | DOAJ |
| description | Abstract Background Evidence from imaging studies suggests a high prevalence of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, there are no criteria for initiating screening for CAD in this population. The current study investigated whether clinical and demographic characteristics can be used to predict significant CAD in patients with T2DM. Methods Computed tomography coronary angiography (CTCA) and laboratory assessments were performed in 259 patients diagnosed with T2DM attending clinics in Northwest London, UK. Coronary artery calcium (CAC) was calculated during CTCA. Significant plaque was defined as one causing more than 50% luminal stenosis. Associations between groups and variables were evaluated using Student’s t test, Chi-square tests and univariate and multivariate regression analysis. P < 0.05 was considered statistically significant. Results Among patients with a median duration of T2DM of 13 years and a mean age of 62.0 years, median CAC score was 105.91 Agatston Units. In a multivariate analyses, duration of diabetes, CAC score and the presence and number of coronary artery plaques and presence of significant plaque were significant predictors of cardiovascular adverse events. Systolic blood pressure (SBP) had borderline significance as a predictor of cardiovascular events (p = 0.05). In a receiver operating characteristic curve (ROC) analysis, duration of diabetes of > 10.5 years predicted significant CAD (sensitivity, 75.3%; specificity 48.2%). Area under the ROC curve was 0.67 when combining duration of T2DM > 10.5 years and SBP of > 139 mm Hg. Adverse cardiovascular events after a median follow-up of 22.8 months were also significantly higher in those with duration of T2DM > 10.5 years and SBP > 140 mm Hg (log rank p = 0.02 and 0.009, respectively). Conclusions Routine screening for CAD using CTCA should be considered for patients with a diagnosis of T2DM for > 10.5 years and SBP > 140 mm Hg. Trial registration Clinicaltrials.gov identifier: NCT02109835, 10 April 2014 (retrospectively registered) |
| first_indexed | 2024-12-13T15:44:02Z |
| format | Article |
| id | doaj.art-548ecceecce949afa4015164000f04a7 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-13T15:44:02Z |
| publishDate | 2019-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-548ecceecce949afa4015164000f04a72022-12-21T23:39:45ZengBMCCardiovascular Diabetology1475-28402019-04-011811910.1186/s12933-019-0855-8Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED studyShreenidhi M. Venuraju0Avijit Lahiri1Anand Jeevarethinam2Mark Cohen3Daniel Darko4Devaki Nair5Miranda Rosenthal6Roby D. Rakhit7Institute of Cardiovascular Science, University College LondonBritish Cardiac Research TrustInstitute of Cardiovascular Science, University College LondonBarnet HospitalThe Jeffrey Kelson Centre for Diabetes and Endocrinology, Central Middlesex HospitalDepartment of Diabetes and Endocrinology, Royal Free HospitalDepartment of Diabetes and Endocrinology, Royal Free HospitalInstitute of Cardiovascular Science, University College LondonAbstract Background Evidence from imaging studies suggests a high prevalence of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, there are no criteria for initiating screening for CAD in this population. The current study investigated whether clinical and demographic characteristics can be used to predict significant CAD in patients with T2DM. Methods Computed tomography coronary angiography (CTCA) and laboratory assessments were performed in 259 patients diagnosed with T2DM attending clinics in Northwest London, UK. Coronary artery calcium (CAC) was calculated during CTCA. Significant plaque was defined as one causing more than 50% luminal stenosis. Associations between groups and variables were evaluated using Student’s t test, Chi-square tests and univariate and multivariate regression analysis. P < 0.05 was considered statistically significant. Results Among patients with a median duration of T2DM of 13 years and a mean age of 62.0 years, median CAC score was 105.91 Agatston Units. In a multivariate analyses, duration of diabetes, CAC score and the presence and number of coronary artery plaques and presence of significant plaque were significant predictors of cardiovascular adverse events. Systolic blood pressure (SBP) had borderline significance as a predictor of cardiovascular events (p = 0.05). In a receiver operating characteristic curve (ROC) analysis, duration of diabetes of > 10.5 years predicted significant CAD (sensitivity, 75.3%; specificity 48.2%). Area under the ROC curve was 0.67 when combining duration of T2DM > 10.5 years and SBP of > 139 mm Hg. Adverse cardiovascular events after a median follow-up of 22.8 months were also significantly higher in those with duration of T2DM > 10.5 years and SBP > 140 mm Hg (log rank p = 0.02 and 0.009, respectively). Conclusions Routine screening for CAD using CTCA should be considered for patients with a diagnosis of T2DM for > 10.5 years and SBP > 140 mm Hg. Trial registration Clinicaltrials.gov identifier: NCT02109835, 10 April 2014 (retrospectively registered)http://link.springer.com/article/10.1186/s12933-019-0855-8AtherosclerosisComputed tomography coronary angiographyCoronary artery calciumRisk stratificationSilent coronary artery diseaseType 2 diabetes mellitus |
| spellingShingle | Shreenidhi M. Venuraju Avijit Lahiri Anand Jeevarethinam Mark Cohen Daniel Darko Devaki Nair Miranda Rosenthal Roby D. Rakhit Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study Cardiovascular Diabetology Atherosclerosis Computed tomography coronary angiography Coronary artery calcium Risk stratification Silent coronary artery disease Type 2 diabetes mellitus |
| title | Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study |
| title_full | Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study |
| title_fullStr | Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study |
| title_full_unstemmed | Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study |
| title_short | Duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population: PROCEED study |
| title_sort | duration of type 2 diabetes mellitus and systolic blood pressure as determinants of severity of coronary stenosis and adverse events in an asymptomatic diabetic population proceed study |
| topic | Atherosclerosis Computed tomography coronary angiography Coronary artery calcium Risk stratification Silent coronary artery disease Type 2 diabetes mellitus |
| url | http://link.springer.com/article/10.1186/s12933-019-0855-8 |
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