Introduction:
Over the last decade, the prevalence of Type 2 diabetes (T2DM) has been significantly increased among the young population. However, the appropriate age to institute statin therapy for treatment of coronary artery disease (CAD) among this population is yet to be defined. In this study, we sought to examine the prevalence, and severity of CAD among the young T2DM population.
Methods:
We enrolled asymptomatic patients within the age range of 25 to 40 who underwent cardiac computed tomography (cardiac CT). Patients with type 1 diabetes, with history of less than 5 years T2DM, or with a history of stent or bypass were excluded. On the day of cardiac CT, self-reported demographic data was collected. All contrast and non-contrast enhanced cardiac CTs were reviewed by two certified expert cardiologists.
Results:
Total of 233 cases with an average age of 35.9 were enrolled. In this population, 38.6% were female, 167 cases (71.7%) were non-diabetic, and 55 cases (25.3%) had abnormal CAC score. There was a very strong trend towards increased prevalence of abnormal CAC score between diabetic and non-diabetic groups (33.8% vs 21.7%, respectively; p=0.06). Based on the cardiac CT angiography, 56.9% of young T2DM patients had coronary atherosclerosis which was significantly greater in comparison to the non-diabetic group (56.9% vs. 35.8%, p=0.007). Regression analyses adjusted for age, gender, dyslipidemia, hypertension, smoking, and family history of premature CAD, showed significantly greater risk of having CAD in T2DM group (OR=3.28, 95% CI: 1.30, 8.29,p<0.05). Both the severity of stenosis and number of involved segments were also significantly greater among T2DM cases. There was no gender or race specific difference in the prevalence of CAD among diabetic patients. Average of CT angiographies’ radiation dose was 2.45 milliSieverts (range:0.8-10.2 mSv).
Conclusions:
In total, more than half of 25-40 years old patients with history for at least 5 years of T2DM had CAD. The difference between positive CAC and CAD by CTA angiography indicates a high prevalence of soft plaques. With mean doses of approximately 2 millisieverts, cardiac CT angiography needs to be considered as a screening method for young T2DM patients.
ABSENCE OF CORONARY ARTERY CALCIUM DOES NOT FULLY EXCLUDE OBSTRUCTIVE CORONARY ARTERY DISEASE AND FUTURE ADVERSE EVENTS AMONG PATIENTS REFERRED FOR CARDIAC CT ANGIOGRAPHY: RESULTS FROM 17,528 PATIENTS IN THE CONFIRM REGISTRY (CORONARY CT ANGIOGRAPHY EVALUATION FOR CLINICAL OUTCOMES: AN INTERNATIONAL MULTICENTER REGISTRY)