Anatomical, genetic, and clinical risk measures showed limited concordance in adults with type 2 diabetes, with only 8.7% simultaneously classified as high risk across all three domains.
Cross-Sectional (n=126)
In adults with type 2 diabetes, there is substantial heterogeneity and limited concordance between anatomical, genetic, and clinical cardiovascular risk measures, supporting the need for integrated risk assessment.
Abstract Background Type 2 diabetes mellitus (T2D) is associated with elevated cardiovascular risk, yet coronary atherosclerotic burden and inherited genetic risk vary substantially between individuals, limiting the precision of conventional risk stratification. Purpose To describe baseline clinical characteristics, CT coronary angiography (CTCA) findings, and polygenic risk score (PRS) distributions in participants enrolled in the VOLTAIRE study. Methods This cross-sectional analysis included adults with T2D who completed baseline CTCA and PRS assessment prior to randomisation in the VOLTAIRE study (Evaluation of polygenic scores and CT imaging in risk factor modification in type 2 diabetes). Coronary atherosclerotic burden was characterised using coronary artery calcium (CAC) scores and CTCA-reported luminal stenosis severity. Polygenic risk for coronary artery disease was assessed using a genome-wide PRS and categorised for descriptive analyses. Results Among 126 participants (mean age 57.5 ± 8.7 years; 62.7% male), coronary anatomy was highly heterogeneous. Over one-third had no detectable coronary calcification (CAC=0), while 18.7% demonstrated severe calcification (CAC ≥400). Moderate-to-severe luminal stenosis (≥50%) was present in 40.5% of participants, including 20.4% classified as low clinical cardiovascular risk. PRS distribution was also variable (low 37.3%, intermediate 35.7%, high 27.0%). Across PRS strata, moderate-to-severe stenosis was observed in 50.0% of those with high PRS, 48.9% with intermediate PRS, and 25.5% with low PRS, indicating incomplete alignment between inherited and anatomical risk. Concordance across risk domains was limited, with only 8.7% of participants simultaneously classified as high risk by anatomical (≥50% stenosis), genetic (PRS ≥67), and clinical (5-year CVD risk ≥15%) criteria, highlighting frequent discordance between risk assessment modalities. Conclusions Baseline findings demonstrate substantial heterogeneity and limited concordance between anatomical, genetic, and clinical risk measures in adults with T2D. These results underscore the multidimensional nature of cardiovascular risk and support the rationale for integrated, personalised risk assessment strategies to better inform prevention and management.
Chen et al. (Wed,) conducted a cross-sectional in Type 2 diabetes mellitus (n=126). Polygenic risk score and coronary computed tomography angiography was evaluated on Concordance across anatomical, genetic, and clinical risk domains. Anatomical, genetic, and clinical risk measures showed limited concordance in adults with type 2 diabetes, with only 8.7% simultaneously classified as high risk across all three domains.