Diabetes Patients With Mild Coronary Artery Disease at Risk

Lara C. Pullen, PhD

December 03, 2014

CHICAGO — For patients with diabetes, even mild coronary artery disease can increase the risk for death, according to new research from the CONFIRM Registry.

CONFIRM involved 34,000 patients from 17 centers in nine countries, 12,086 of whom had follow-up of at least five years.

"The CONFIRM Registry is an all-comers, real-world prospective registry," said researcher Jonathon Leipsic, MD, from the University of British Columbia in Vancouver, Canada. This study was not interventional; rather, "what we are trying to do is learn how to guide prognosis," he explained.

Philipp Blanke, MD, also from the University of British Columbia, presented an analysis of data from the registry here at the Radiological Society of North America 100th Annual Meeting.

"An interesting finding from our study was that patients with mild disease had a very similar prognosis to patients with one-vessel disease," said Dr Blanke.

The researchers identified 1823 patients who had diabetes, three-quarters of whom had evidence of coronary artery disease on CT angiography.

After more than five years of follow-up, 246 (13.5%) of the patients with diabetes had died.

The more coronary vessels exhibiting obstructive coronary disease, the greater the risk for death. Patients with diabetes who did not have evidence of coronary disease had a relatively low death rate.

Patients with 1% to 49% stenosis were considered to have mild coronary disease, and those with at least 50% stenosis were considered to have obstructive disease.

A risk-adjusted analysis found that both conditions were associated with an increased risk for death. The prognosis of patients with mild disease was similar to that of patients with single-vessel obstructive disease.

Table. Mortality Risk for Patients With Diabetes

Coronary Artery Disease Severity Hazard Ratio 95% Confidence Interval P Value
Mild 2.0 1.3–3.1 .003
Obstructive 2.1 1.4–3.2 <.001

 

In radiology, "it's not often that we have such large studies," said Max Wintermark, MD, from the Stanford University Medical Center in California. "I think it's quite interesting to see structural imaging showing the wall can stratify risk," he told Medscape Medical News.

The prevalence of diabetes, a known risk factor for coronary artery disease, is increasing rapidly — at a rate that parallels the increasing prevalence of obesity.

Although these results do not indicate that all patients with diabetes should be screened with CT angiography, said Dr Leipsic, the images are "quite compelling for a patient" and can help motivate them to take better care of themselves. Angiography findings of coronary disease can be used to provide long-term prognostic information for patients with diabetes.

The results suggest that patients with diabetes who have evidence of mild coronary artery disease might benefit from more aggressive medical therapy than they are currently receiving. Dr Blanke was quick to point out, however, that such a hypothesis needs to be investigated in prospective studies.

Another interesting aspect of the study is that the median age of the patients at follow-up was 62 years, which means that they had their CT when they were approximately 57 years old, the researchers report.

One-quarter of these patients did not have atherosclerosis. It would be interesting to determine what differentiated these patients from the majority of patients in the cohort who did have coronary artery disease, said Dr Leipsic.

There was no commercial funding for this study. Dr Blanke has disclosed no relevant financial relationships. Dr Leipsic reports being a member of the General Electric Company speakers bureau, and a consultant for Edwards Lifesciences Corporation, HeartFlow, and Circle Cardiovascular Imaging. Dr Wintermark reports receiving research grants from General Electric Company and Koninklijke Philips NV.

Radiological Society of North America (RSNA) 100th Annual Meeting: Abstract SSM03-04. Presented December 3, 2014.

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