Key result
Maintaining normal SBP linked to ~19% lower risk of CAC progression in nondiabetic adults.
Why the study?
To assess the association between maintaining normal systolic blood pressure and coronary artery calcification progression in non-diabetic and diabetic individuals at low to intermediate cardiovascular risk.
Does maintaining normal systolic blood pressure (<120 mmHg) prevent coronary artery calcification progression in asymptomatic adults with or without diabetes?
Cohort (n=10,754)
Yes
Does maintaining normal systolic blood pressure (<120 mmHg) prevent coronary artery calcification progression in asymptomatic adults with or without diabetes?
Maintaining normal systolic blood pressure (<120 mmHg) is associated with attenuated coronary artery calcification progression in asymptomatic adults without diabetes, but this benefit is not observed in those with established diabetes.
May attenuate CAC progression in non-diabetics; leaves open differential effects by diabetes status and needs prospective validation.
Objectives To assess the association of normal systolic blood pressure maintenance (SBP maintain ) with coronary artery calcification (CAC) progression in non-diabetic and diabetic subjects at low to intermediate cardiovascular risk. Design Retrospective cohort study with a mean follow-up of 3.3 years. Setting Data from the Korea Initiatives on Coronary Artery Calcification registry were analysed. Participants 10 754 asymptomatic Korean adults (51.5±8.6 years; 84.5% male; 14.2% diabetes) were enrolled. Participants were divided into two groups: normal SBP maintain (<120 mmHg) and ≥elevated SBP maintain (≥120 mmHg) at the time of follow-up CAC scan. Main outcome measures CAC progression was defined as a difference of ≥2.5 between the square roots (√) of the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS). Annualised Δ√transformed CACS was defined as Δ√transformed CACS divided by the interscan period. Results Compared with non-diabetics, the incidence of CAC progression was higher in diabetics (28.4% vs 47.3%, p<0.001) during a mean follow-up of 3.3 years. Normal SBP maintain was inversely associated with an annualised Δ√transformed CACS (β: −0.18, 95% CI: −0.25 to −0.12, p<0.001) in non-diabetics, but not in diabetics (β: −0.07, 95% CI: −0.31 to 0.19, p=0.631). After consecutive adjustments of age, sex, hypertension, dyslipidaemia, obesity, current smoking and baseline CACS, normal SBP maintain showed a lower risk of CAC progression than ≥elevated SBP maintain in non-diabetics; however, this association was not observed in patients with diabetes. Conclusions Maintaining normal systolic blood pressure was associated with a significantly attenuated CAC progression, especially in clinical conditions without established diabetes.
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Won et al. (2025) conducted a cohort in Asymptomatic adults at low to intermediate cardiovascular risk (n=10,754). Normal systolic blood pressure maintenance (<120 mmHg) vs. Elevated systolic blood pressure maintenance (≥120 mmHg) was evaluated on Coronary artery calcification (CAC) progression in non-diabetics (HR 0.81, 95% CI 0.75-0.88, p=<0.001). Maintaining normal systolic blood pressure (<120 mmHg) was independently associated with a lower risk of coronary artery calcification progression (HR 0.81) in asymptomatic adults without diabetes.
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