Association of diabetic foot with coronary plaque characteristics and outcomes in type 2 diabetes

BACKGROUND Diabetic foot (DF), a serious complication of type 2 diabetes mellitus (T2DM), notably increases the risk of cardiovascular disease.AIM To characterize coronary plaque characteristics in clinically referred patients with T2DM with and without DF using coronary computed tomography angiography (CCTA), and associations between DF and plaque features, and long-term outcomes.METHODS This retrospective single-center study enrolled 272 patients diagnosed with T2DM who underwent CCTA, including 127 and 145 patients with and without DF, respectively.The coronary artery calcium score (CACS), percent atheroma volume (PAV), and high-risk plaque (HRP) features were assessed via CCTA.Inverse probability of treatment weighting (IPTW) and multivariable regression were used to adjust for confounding, and survival analysis was performed.Effect estimates are reported as odds ratios (OR), β coefficients, hazard ratios (HR), subdistribution HR (sHRs), and 95% confidence intervals (CI).RESULTS Patients with DF had significantly higher CACS [343 (58, 994) vs 27 (0, 150)], quantitative plaque burden, and prevalence of HRP (93.7% vs 68.3%) (all P < 0.001).After IPTW and multivariable adjustment, DF remained associated with HRP [OR: 8.53 (95%CI: 3.04-23.91)],total PAV [β: 8.22 (95%CI: 5.62-10.81)],and non-calcified PAV [β: 4.50 (95%CI:3.00-6.01)](all P < 0.001).For the two exploratory endpoints, over a median follow-up of 3.3 years, DF was significantly associated with an increased risk of all-cause mortality [HR: 10.59 (95%CI: 4.53-24.75),P < 0.001].In comparison, while the risk of major adverse 4 / 44 cardiovascular events was numerically higher in the DF group, this difference did not reach statistical significance [sHR: 1.77 (95%CI: 0.84-3.75),P = 0.136]. CONCLUSIONAmong patients with T2DM who were referred for CCTA, DF was associated with greater coronary atherosclerotic burden and a higher prevalence of HRP.These findings provide further insights into the burden of coronary atherosclerosis and plaque vulnerability in this selected population.