Rapid progression of coronary atherosclerosis across glycemic status: a serial coronary computed tomography angiography study from the PARADIGM registry

Rapid progression of coronary atherosclerosis is associated with an increased risk of future adverse cardiovascular events. However, evidence regarding the association between glycemic status and rapid plaque progression (RPP) in the major epicardial coronary arteries remains limited. A total of 1296 subjects (mean age, 61 ± 9 years; 56.9% men) from the PARADIGM (Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography IMaging) registry who underwent serial coronary computed tomography angiography and had available glycemic data were included. The median inter-scan interval was 3.2 (interquartile range, 2.6–4.4) years. Participants were classified according to glycemic status as having normal glycemic status, prediabetes, or diabetes. Percent atheroma volume (PAV) was calculated as plaque volume divided by vessel volume and multiplied by 100. RPP was defined as an increase in PAV of ≥ 1.0%/year. Annual changes in PAV (%/year) differed significantly across glycemic groups (normal glycemic status, 0.30 [0.00–0.98]; prediabetes, 0.35 [0.04–0.98]; diabetes, 0.65 [0.19–1.54]; overall P < 0.001). Similarly, the incidence of RPP differed significantly across glycemic groups (normal glycemic status, 25.6%; prediabetes, 25.2%; diabetes, 38.5%; overall P < 0.001). In multivariable logistic regression analyses adjusting for clinical risk factors and baseline plaque burden, diabetes was independently associated with higher odds of RPP compared with normal glycemic status, whereas prediabetes was not. Among participants without diabetes at baseline, RPP was more frequent in those who developed new-onset diabetes than in those who did not (36.1% vs. 24.2%; P = 0.039). Diabetes, but not prediabetes, was independently associated with rapid progression of coronary atherosclerosis. Furthermore, the higher incidence of RPP among participants who developed new-onset diabetes suggests that the development of diabetes may represent an important threshold for accelerated coronary plaque progression. Trial registration : ClinicalTrials.gov (NCT02803411).