Coronary plaque burden assessed by coronary CT angiography in individuals with type 1 diabetes and healthy controls

Cardiovascular disease (CVD) remains a prominent cause of death in individuals with type 1 diabetes (T1D). It is unknown whether guideline-recommended initiation of statin therapy at the age of 40 years is adequate for primary prevention of CVD. We evaluated the coronary plaque burden in asymptomatic individuals with T1D compared with healthy controls. Individuals with T1D who used continuous glucose monitoring (CGM) sensors were compared with healthy controls. CGM data from ≥ 1 year prior to enrollment were obtained. All participants underwent coronary computed tomography angiography, which was followed by atherosclerosis imaging-quantitative computed tomography. Fifty-eight individuals with T1D and 45 healthy controls (mean age 42.1 ± 4.9 vs. 41.0 ± 3.5 years) participated. The participants with diabetes had a median disease duration of 24 years [IQR 17, 30]. The prevalence of significant coronary plaque was similar in both groups (31% vs. 22%) (OR 2.71 [95% CI 0.9 to 9.07]), as were plaque volumes and the presence of high-risk plaque, even after adjusting for clinical risk factors. Participants with T1D had a median time in range of 71% [IQR 52, 79] and a mean HbA1c of 55 ± 12 mmol/mol. The CGM metrics (time in range, time above range, time below range and glucose coefficient of variation) were not associated with plaque volumes. Individuals with long-standing well-regulated T1D and on-target lipid levels and blood pressure, exhibited a similar coronary plaque burden compared with healthy controls. These findings support early and aggressive risk factor management in T1D.