High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Suspected stable coronary artery disease with low-attenuation plaque (LAP) lesions (n=148). Intervention: Impaired glucose tolerance (IGT) vs. Normal glucose tolerance (NGT). Primary outcome: Napkin-ring sign (NRS) frequency in low-attenuation plaque lesions (OR 2.7, p=0.02).

Thomas Rueskov Andersen; Katrine Schultz Overgaard; Laurits Juhl Heinsen; Roda Abdulkadir Mohamed; Freja Sønder Madsen; Helle Precht; Jess Lambrechtsen; Søren Auscher; Kenneth Egstrup

doi:10.3390/jcdd12020037

January 22, 2025Journal of Cardiovascular Development and DiseaseOpen Access

High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study

View Full Paper

Ask AI

Bookmark

Share

Key result

Impaired glucose tolerance linked to ~2.7-fold higher odds of coronary napkin-ring signs.

OR 2.7
P=0.02
n=148

Figures

Why the study?

Impaired glucose tolerance is a risk factor for CAD, and low-attenuation plaque lesions confer high risk of coronary events, but high-risk plaque characteristics had not been evaluated between patients with IGT and NGT.

Does impaired glucose tolerance increase high-risk coronary plaque characteristics in patients with suspected stable coronary artery disease compared to normal glucose tolerance?

Key Points

To evaluate high-risk plaque characteristics within low-attenuation plaque lesions between patients with impaired glucose tolerance and normal glucose tolerance presenting with suspected stable coronary artery disease.
Cross-sectional observational study analyzing an initial cohort of 312 patients with suspected stable coronary artery disease undergoing coronary computed tomography angiography (CCTA).
Glycemic tolerance was defined via oral glucose tolerance tests, identifying 148 patients (93 with normal glucose tolerance [NGT] and 55 with impaired glucose tolerance [IGT]) who had 202 low-attenuation plaque (LAP) lesions for detailed plaque analysis.
Patients with IGT had a significantly higher prevalence of LAP lesions compared with NGT (60% vs. 42%, p = 0.007).
LAP burden was significantly greater in the IGT group compared to NGT (10.79 ± 6.84% vs. 8.62 ± 5.93%, p = 0.02), remaining significant after multivariate adjustment (β = 0.3, p = 0.03).
The napkin-ring sign occurred more frequently in IGT lesions than NGT lesions (12% vs. 5%, p = 0.02), with an adjusted odds ratio of 2.7 (p = 0.02).

Study Design

Type

Observational (n=148)

Blinding

Single-blind (images blinded to observer)

Multicenter

No

Structured PICO

Does impaired glucose tolerance increase high-risk coronary plaque characteristics in patients with suspected stable coronary artery disease compared to normal glucose tolerance?

P

Population

148 patients (mean age ~63) with suspected stable CAD and at least one low-attenuation plaque lesion, stratified by glucose tolerance to assess coronary plaque vulnerability.

E

Exposure

Impaired glucose tolerance (IGT) as stratified by oral glucose tolerance test (OGTT)

C

Comparator

Normal glucose tolerance (NGT) as stratified by oral glucose tolerance test (OGTT)

O

Outcome

High-risk plaque characteristics (specifically low-attenuation plaque burden and napkin-ring sign) evaluated by coronary computed tomography angiography (CCTA)surrogate

Main Result

Odds Ratio: 2.7

Absolute Event Rate: 12% vs 5%

p-value: p=0.02

Impaired glucose tolerance is independently associated with more vulnerable, high-risk coronary plaque characteristics, which may help explain the increased cardiovascular risk in prediabetic patients.

Limitations

Cross-sectional nature limits the ability to establish causal relationships
Delay between CCTA and blood sampling
OGTT was based on a single measurement, which may lack reproducibility
Potential errors introduced by semi-automatic plaque measurements requiring manual correction
Generalizability limited by focus on a specific subset of patients with LAP lesions
Cross-sectional nature limits causal inferences
Delay between CCTA and blood sampling (mean 29 days)
OGTT based on a single measurement with questioned intrapersonal reproducibility
Use of semi-automatic plaque measurements with manual corrections
Small sample size restricted to a specific subset of patients with LAP lesions

Implication

May inform CAD risk stratification in suspected stable disease; hypothesis-generating for IGT-targeted prevention and requires prospective validation.

Abstract

Impaired glucose tolerance (IGT), a prediabetic state, is a known risk factor for coronary artery disease (CAD). Low-attenuation plaque (LAP) lesions are associated with a high risk of coronary events. We aimed to evaluate high-risk plaque characteristics in LAP lesions between patients with IGT and normal glucose tolerance (NGT) in patients suspected for stable CAD. Coronary computed tomography angiography (CCTA) identified LAP lesions and assessed plaque volumes, burdens, and high-risk plaque features. Glycemic tolerance was stratified using oral glucose tolerance tests. Among 148 patients, 202 LAP lesions were identified, with 93 patients classified as NGT and 55 as IGT. Patients with IGT had a significantly higher prevalence of LAP lesions compared with NGT (p = 0.007). LAP volume was higher in IGT (16.46 ± 12.52 mm3) compared with NGT (12.66 ± 9.72 mm3, p = 0.01), but this association did not persist in multivariate analysis. The LAP burden was greater in IGT (10.79 ± 6.84%) than NGT (8.62 ± 5.93%, p = 0.02), and the napkin-ring sign was more frequent in IGT (12%) versus NGT (5%, p = 0.02); these associations remained significant in multivariate analysis. Patients with IGT had a higher LAP burden and higher frequency of napkin-ring signs. These findings may help explain the common occurrence of prediabetes in patients with acute myocardial infarction.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Andersen et al. (2025) conducted an observational in Suspected stable coronary artery disease with low-attenuation plaque (LAP) lesions (n=148). Impaired glucose tolerance (IGT) vs. Normal glucose tolerance (NGT) was evaluated on Napkin-ring sign (NRS) frequency in low-attenuation plaque lesions (OR 2.7, p=0.02). In patients with suspected stable CAD, impaired glucose tolerance was independently associated with a significantly higher frequency of napkin-ring signs (OR 2.7, p=0.02) compared to normal glucose tolerance.

synapsesocial.com/papers/6a20aff63678e79550f9e340 https://doi.org/10.3390/jcdd12020037

Topics

Coronary artery disease

Coronary CT angiography

View Full Paper

Ask AI

Bookmark

Share

High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

High-Risk Plaque Characteristics in Patients with Suspected Stable Coronary Artery Disease and Impaired Glucose Tolerance: A Coronary Computed Tomography Angiography Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

More related papers

More on Coronary artery disease

More from Journal of Cardiovascular Development and Disease

Topics

Keep reading

More related papers

More on Coronary artery disease

More from Journal of Cardiovascular Development and Disease