Key result
Smoking in patients with type 2 diabetes mellitus is independently associated with a significantly higher risk of obstructive coronary artery plaques (OR 1.884) compared to nonsmokers.
Why the study?
The effect of smoking on coronary artery plaques examined by CCTA in type 2 diabetes mellitus patients is not fully understood.
Does smoking history increase the risk of noncalcified, obstructive, and extensive coronary artery plaques in patients with type 2 diabetes mellitus?
Cross-Sectional (n=1,058)
Blinded to clinical information
No
Does smoking history increase the risk of noncalcified, obstructive, and extensive coronary artery plaques in patients with type 2 diabetes mellitus?
Odds Ratio: 1.884 (95% CI 1.458–2.436)
p-value: p=<0.001
Smoking is independently associated with a higher burden of noncalcified, obstructive, and extensive coronary artery plaques in patients with type 2 diabetes, with longer smoking duration further increasing this risk.
May warrant enhanced smoking cessation counseling in T2DM; leaves open prospective effects on plaque progression.
Background: The effect of smoking on coronary artery plaques examined by coronary computed tomography angiography (CCTA) in type 2 diabetes mellitus (DM) patients is not fully understood. This study explored the effect of smoking on coronary artery plaques by comparing the characteristics of plaques between diabetes patients with and without a smoking history and among those with different smoking durations. Materials and Methods: In total, 1058 DM patients found to have coronary plaques on CCTA were categorized into the smoker (n=448) and nonsmoker groups (n=610). Smokers were stratified by smoking duration [≤20 years (n=115), 20~40 years (n=233) and >40 years (n=100)]. The plaque types, luminal stenosis [obstructive (<50%) or nonobstructive (≥50%) stenosis], segment involvement score (SIS), and segment stenosis score (SSS) of the CCTA data were compared among groups. Results: Compared to nonsmokers, smokers demonstrated increased odds ratios (ORs) of any noncalcified plaques (OR=1.423; P=0.014), obstructive plaques (OR=1.884; P<0.001), multivessel disease (OR=1.491; P=0.020), SIS≥4 (OR=1.662; P<0.001), and SSS≥7 (OR=1.562; P=0.001). Compared to diabetes patients with a smoking duration ≤20 years, those with a smoking duration of 20~40 years and >40 years had higher OR of any mixed plaques (OR=2.623 and 3.052, respectively; Ps<0.001), obstructive plaques (OR=2.004 and 2.098; P=0.003 and 0.008, respectively), multivessel disease (OR=3.171 and 3.784; P<0.001 and P=0.001, respectively), and SSS≥7 (OR=1.605 and 1.950; P=0.044 and 0.020, respectively). Diabetes with a smoking duration >40 years had a higher OR of SIS≥4 (OR=1.916, P=0.034). Conclusion: Smoking is independently associated with the presence of noncalcified, obstructive, and more extensive coronary artery plaques in diabetes patients, and a longer smoking duration is significantly associated with a higher risk of mixed, obstructive, and more extensive plaques.
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Jiang et al. (2021) conducted a cross-sectional in Type 2 Diabetes Mellitus with coronary artery plaques (n=1,058). Smoking vs. Nonsmokers was evaluated on Presence of any obstructive coronary artery plaque (OR 1.884, 95% CI 1.458-2.436, p=<0.001). Smoking in patients with type 2 diabetes mellitus is independently associated with a significantly higher risk of obstructive coronary artery plaques (OR 1.884) compared to nonsmokers.
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