Nezarat Negin, Budoff Matthew J, Luo Yanting, Darabian Sirous, Nakanishi Rine, Li Dong, Sheidaee Nasim, Kim Michael, Alani Anas, Matsumoto Suguru, Rahmani Sina, Kanisawa Mitsuru, Ceponiene Indre, Osawa Kazuhiro, Qi Hong, Hamal Sajad, Kitslaar Pieter, Broersen Alexander, Flores Ferdinand, Ipp Eli, Khazai Bahram
Department of Cardiology, Los Angeles Biomedical Research Institute, Torrance, California.
Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
Am J Cardiol. 2017 May 15;119(10):1566-1571. doi: 10.1016/j.amjcard.2017.02.023. Epub 2017 Mar 1.
Prevention and management of coronary artery disease (CAD) is of great concern in patients with diabetes mellitus. Although the impact of coronary atherosclerosis is described well for subjects older than 40 years, the prevalence and types of coronary atherosclerosis in young patients are not well known. The aim of this study was to evaluate the prevalence, extent, severity, and volumes of coronary plaque in type 2 diabetes mellitus (T2DM) population younger than of 40 years. This prospective study enrolled 181 subjects (25-40 year old) undergoing coronary computed tomography angiography, with 86 T2DM and 95 nondiabetic age/gender-matched subjects. Coronary artery calcium (CAC), plaque assessment including total segment stenosis (sum of individual segmental stenosis), total plaque scores (sum of semiquantitative segmental plaque burden), segment involvement scores (number of segments with plaque) were evaluated. In addition, we quantitatively measured plaque volumes in total, fibrous, fibrous fatty, dense calcified, and low-attenuation plaque using novel plaque software. Compared with nondiabetic patients, the prevalence of CAD, calcified, and noncalcified plaques was higher in patients with T2DM (19% vs 58%; p <0.001). In patients with a zero CAC, T2DM had a higher prevalence (46%) of noncalcified plaque (p <0.0001). In multivariate linear regression models after adjusting for traditional cardiovascular risk factors, increased total segmental stenosis, total plaque scores, and segment involvement scores were associated with T2DM. Regarding quantitative plaque assessment, all volumes in noncalcified plaque type were approximately threefold higher in patients with T2DM. In conclusion, young patients with T2DM are susceptible to premature CAD with more calcified and noncalcified plaques. Early prevention program using computed tomography angiography might be helpful in identifying young diabetic patients with subclinical atherosclerosis.
冠心病（CAD）的预防和管理是糖尿病患者极为关注的问题。尽管对于40岁以上人群冠状动脉粥样硬化的影响已有充分描述，但年轻患者冠状动脉粥样硬化的患病率及类型尚不明确。本研究旨在评估40岁以下2型糖尿病（T2DM）人群冠状动脉斑块的患病率、范围、严重程度及体积。这项前瞻性研究纳入了181名接受冠状动脉计算机断层扫描血管造影的受试者（年龄在25 - 40岁），其中86名T2DM患者和95名年龄及性别匹配的非糖尿病受试者。评估了冠状动脉钙化（CAC）、斑块情况，包括总节段狭窄（各节段狭窄之和）、总斑块评分（半定量节段斑块负荷之和）、节段累及评分（有斑块的节段数）。此外，我们使用新型斑块软件对总斑块、纤维斑块、纤维脂肪斑块、致密钙化斑块和低衰减斑块的体积进行了定量测量。与非糖尿病患者相比，T2DM患者CAD、钙化斑块和非钙化斑块的患病率更高（19%对58%；p<0.001）。在CAC为零的患者中，T2DM患者非钙化斑块的患病率更高（46%）（p<0.0001）。在调整传统心血管危险因素后的多变量线性回归模型中，总节段狭窄增加、总斑块评分增加和节段累及评分增加与T2DM相关。关于定量斑块评估，T2DM患者非钙化斑块类型的所有体积大约高出三倍。总之，年轻的T2DM患者易患早发性CAD，且有更多的钙化和非钙化斑块。使用计算机断层扫描血管造影的早期预防方案可能有助于识别患有亚临床动脉粥样硬化的年轻糖尿病患者。
