Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study

Ung Kim, Jonathon A. Leipsic, Stephanie L. Sellers, Michael Shao, Philipp Blanke, Martin Hadamitzky, Yong Jin Kim, Edoardo Conte, Daniele Andreini, Gianluca Pontone, Matthew J. Budoff, Ilan Gottlieb, Byoung Kwon Lee, Eun Ju Chun, Filippo Cademartiri, Erica Maffei, Hugo Marques, Sanghoon Shin, Jung Hyun Choi, Renu VirmaniHabib Samady, Peter H. Stone, Daniel S. Berman, Jagat Narula, Leslee J. Shaw, Jeroen J. Bax, James K. Min, Hyuk Jae Chang

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objectives: This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM). Background: The natural history of coronary PP in patients with DM is not well established. Methods: A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0. Results: DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (−7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM. Conclusions: People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.

Original languageEnglish
Pages (from-to)1461-1471
Number of pages11
JournalJACC: Cardiovascular Imaging
Volume11
Issue number10
DOIs
Publication statusPublished - 2018 Oct

Fingerprint

Coronary Artery Disease
Diabetes Mellitus
Angiography
Odds Ratio
Confidence Intervals
Sex Ratio
Atherosclerotic Plaques
Natural History
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Kim, Ung ; Leipsic, Jonathon A. ; Sellers, Stephanie L. ; Shao, Michael ; Blanke, Philipp ; Hadamitzky, Martin ; Kim, Yong Jin ; Conte, Edoardo ; Andreini, Daniele ; Pontone, Gianluca ; Budoff, Matthew J. ; Gottlieb, Ilan ; Lee, Byoung Kwon ; Chun, Eun Ju ; Cademartiri, Filippo ; Maffei, Erica ; Marques, Hugo ; Shin, Sanghoon ; Choi, Jung Hyun ; Virmani, Renu ; Samady, Habib ; Stone, Peter H. ; Berman, Daniel S. ; Narula, Jagat ; Shaw, Leslee J. ; Bax, Jeroen J. ; Min, James K. ; Chang, Hyuk Jae. / Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography : Results of the PARADIGM Study. In: JACC: Cardiovascular Imaging. 2018 ; Vol. 11, No. 10. pp. 1461-1471.
@article{faf2c295597c479d913fcaed53c34d1a,
title = "Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study",
abstract = "Objectives: This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM). Background: The natural history of coronary PP in patients with DM is not well established. Methods: A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3{\%} men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0. Results: DM was an independent risk factor for PP (84.6{\%}; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95{\%} confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95{\%} CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75{\%} (OR: 3.121; 95{\%} CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9{\%} in patients without DM and 36.0 ± 29.7{\%} in those with DM; p = 0.032) and necrotic core volume (−7.0 ± 35.8{\%} in patients without DM and 21.5 ± 90.5{\%} in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM. Conclusions: People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75{\%} at baseline were identified as independent risk factors for PP.",
author = "Ung Kim and Leipsic, {Jonathon A.} and Sellers, {Stephanie L.} and Michael Shao and Philipp Blanke and Martin Hadamitzky and Kim, {Yong Jin} and Edoardo Conte and Daniele Andreini and Gianluca Pontone and Budoff, {Matthew J.} and Ilan Gottlieb and Lee, {Byoung Kwon} and Chun, {Eun Ju} and Filippo Cademartiri and Erica Maffei and Hugo Marques and Sanghoon Shin and Choi, {Jung Hyun} and Renu Virmani and Habib Samady and Stone, {Peter H.} and Berman, {Daniel S.} and Jagat Narula and Shaw, {Leslee J.} and Bax, {Jeroen J.} and Min, {James K.} and Chang, {Hyuk Jae}",
year = "2018",
month = "10",
doi = "10.1016/j.jcmg.2018.04.009",
language = "English",
volume = "11",
pages = "1461--1471",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier Inc.",
number = "10",

}

Kim, U, Leipsic, JA, Sellers, SL, Shao, M, Blanke, P, Hadamitzky, M, Kim, YJ, Conte, E, Andreini, D, Pontone, G, Budoff, MJ, Gottlieb, I, Lee, BK, Chun, EJ, Cademartiri, F, Maffei, E, Marques, H, Shin, S, Choi, JH, Virmani, R, Samady, H, Stone, PH, Berman, DS, Narula, J, Shaw, LJ, Bax, JJ, Min, JK & Chang, HJ 2018, 'Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography: Results of the PARADIGM Study', JACC: Cardiovascular Imaging, vol. 11, no. 10, pp. 1461-1471. https://doi.org/10.1016/j.jcmg.2018.04.009

Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography : Results of the PARADIGM Study. / Kim, Ung; Leipsic, Jonathon A.; Sellers, Stephanie L.; Shao, Michael; Blanke, Philipp; Hadamitzky, Martin; Kim, Yong Jin; Conte, Edoardo; Andreini, Daniele; Pontone, Gianluca; Budoff, Matthew J.; Gottlieb, Ilan; Lee, Byoung Kwon; Chun, Eun Ju; Cademartiri, Filippo; Maffei, Erica; Marques, Hugo; Shin, Sanghoon; Choi, Jung Hyun; Virmani, Renu; Samady, Habib; Stone, Peter H.; Berman, Daniel S.; Narula, Jagat; Shaw, Leslee J.; Bax, Jeroen J.; Min, James K.; Chang, Hyuk Jae.

In: JACC: Cardiovascular Imaging, Vol. 11, No. 10, 10.2018, p. 1461-1471.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Natural History of Diabetic Coronary Atherosclerosis by Quantitative Measurement of Serial Coronary Computed Tomographic Angiography

T2 - Results of the PARADIGM Study

AU - Kim, Ung

AU - Leipsic, Jonathon A.

AU - Sellers, Stephanie L.

AU - Shao, Michael

AU - Blanke, Philipp

AU - Hadamitzky, Martin

AU - Kim, Yong Jin

AU - Conte, Edoardo

AU - Andreini, Daniele

AU - Pontone, Gianluca

AU - Budoff, Matthew J.

AU - Gottlieb, Ilan

AU - Lee, Byoung Kwon

AU - Chun, Eun Ju

AU - Cademartiri, Filippo

AU - Maffei, Erica

AU - Marques, Hugo

AU - Shin, Sanghoon

AU - Choi, Jung Hyun

AU - Virmani, Renu

AU - Samady, Habib

AU - Stone, Peter H.

AU - Berman, Daniel S.

AU - Narula, Jagat

AU - Shaw, Leslee J.

AU - Bax, Jeroen J.

AU - Min, James K.

AU - Chang, Hyuk Jae

PY - 2018/10

Y1 - 2018/10

N2 - Objectives: This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM). Background: The natural history of coronary PP in patients with DM is not well established. Methods: A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0. Results: DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (−7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM. Conclusions: People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.

AB - Objectives: This study aimed to determine the rate and extent of plaque progression (PP), changes in plaque features, and clinical predictors of PP in patients with diabetes mellitus (DM). Background: The natural history of coronary PP in patients with DM is not well established. Methods: A total of 1,602 patients (age 61.3 ± 9.0 years; 60.3% men; median scan interval 3.8 years) who underwent serial coronary computed tomography angiography over a period of at least 24 months were enrolled and analyzed from the PARADIGM (Progression of Atherosclerotic Plaque Determined by Computed Tomographic Angiography Imaging) trial. Study endpoints were changes in plaque features in diabetics with PP and risk factors for PP by serial coronary computed tomography angiography between patients with and without DM. PP was defined if plaque volume at follow-up minus plaque volume at baseline was >0. Results: DM was an independent risk factor for PP (84.6%; 276 of 326 patients with PP) in multivariate analysis (odds ratio [OR]: 1.526; 95% confidence interval [CI]: 1.100 to 2.118; p = 0.011). Independent risk factors for PP in patients with DM were male sex (OR: 1.485; 95% CI: 1.003 to 2.199; p = 0.048) and mean plaque burden at baseline ≥75% (OR: 3.121; 95% CI: 1.701 to 5.725; p ≤0.001). After propensity matching, percent changes in overall plaque volume (30.3 ± 36.9% in patients without DM and 36.0 ± 29.7% in those with DM; p = 0.032) and necrotic core volume (−7.0 ± 35.8% in patients without DM and 21.5 ± 90.5% in those with DM; p = 0.007) were significantly greater in those with DM. The frequency of spotty calcification, positive remodeling, and burden of low-attenuation plaque were significantly greater in patients with DM. Conclusions: People with DM experience greater PP, particularly significantly greater progression in adverse plaque, than those without DM. Male sex and mean plaque burden >75% at baseline were identified as independent risk factors for PP.

UR - http://www.scopus.com/inward/record.url?scp=85046847098&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046847098&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2018.04.009

DO - 10.1016/j.jcmg.2018.04.009

M3 - Article

C2 - 29778853

AN - SCOPUS:85046847098

VL - 11

SP - 1461

EP - 1471

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 10

ER -