446-P: Prognostic Role of Type 2 Diabetes Mellitus in Minor vs. Major Atherosclerosis

The impact of diabetes on major cardiovascular events (MACE) in relation to the extent of pre-existing atherosclerotic disease remains unclear. In this study we compare the impact of T2DM on MACE in patients with two different states of atherosclerosis: minor coronary atherosclerosis (minAS) and peripheral artery disease, one of the most severe manifestations of major atherosclerosis (majAS). We included 1238 patients from two long-term prospective cohort studies. Patients underwent coronary angiography for the allocation to a control group without any lumen irregularities (n=332) or a minAS group with lumen irregularities but no significant coronary stenoses ≥50% at coronary angiography (n=425). Patients with sonographically proven peripheral artery disease were allocated to the majAS group (n= 481). Over a mean time-period of 7.7 years major cardiovascular events (MACE) were recorded. Overall, MACE were recorded in 681 (51%) patients. T2DM significantly increased the risk of MACE both among patients with minAS (22.0% vs. 32.4%; p=0.023) and majAS (50.6% vs. 67.1%; p<0.001) but nut in the control group (12.0% vs. 12.1%; p=0.663). In majAS - patients who did not have T2DM, the risk of MACE was higher than that of T2DM patients with minAS (p<0.001). Both T2DM (adjusted HR=1.78 [1.45-2.17], p<0.001) and severity of atherosclerosis (adjusted HR=2.59 [2.18-3.10], p<0.001) predicted MACE in a mutually independent manner. An interaction term severity of atherosclerosis x T2DM was not significant (p=0.364), indicating that the severity of pre-existing atherosclerosis did not impact the power of T2DM as a predictor of MACE. We conclude that T2DM confers an increased risk for MACE both in early and in advanced atherosclerotic states. The severity of pre-existing atherosclerosis does not impact the power of T2DM as a predictor of MACE.