Diabetes significantly increased the risk of major adverse cardiovascular events (OR 1.82) compared to non-diabetes in patients with diagnosed or high-risk coronary artery disease.
Meta-Analysis (n=4,256)
Does type 2 diabetes mellitus increase the risk of MACE in patients with coronary artery plaques compared to patients without diabetes?
In patients with coronary artery disease, diabetes is associated with a significantly higher risk of MACE, MI, and revascularization across all lesion types compared to patients without diabetes.
Effect estimate: OR 1.82 (95% CI 1.42 to 2.33)
p-value: p=< 0.00001
The classification of major adverse cardiovascular event (MACE) endpoints in patients with type 2 diabetes mellitus (T2DM) and either confirmed coronary artery disease (CAD) or high CAD risk, as well as the extent of the association between T2DM and coronary plaque characteristics, remains uncertain. This meta-analysis aims to compare MACE endpoints between patients with diabetes and patients without diabetes based on coronary artery plaques. We searched studies from Web of Science, PubMed, Embase, and the Cochrane Library up until September 1, 2023. Two independent researchers evaluated the quality and bias of the included studies. We used odds ratio (OR) and standardized mean difference (SMD) with 95% confidence interval (CI) to assess the effect of individual lesion parameters and coronary artery plaque characteristics on MACE endpoints. Seven studies covered 1218 patients with diabetes and 3038 patients without diabetes. The follow-up time ranged from 2 to 5.4 years. The pooled results indicated that in all CAD lesions, DM was more strongly associated with MACE, myocardial infarction (MI), revascularization, and rehospitalization for unstable or progressive angina. The pooled OR was 1.82 (95% CI: 1.42 to 2.33, I2 = 0%, P < 0.00001) for MACE, 2.36 (95% CI: 1.47 to 3.79, I2 = 0%, P = 0.0004) for MI, 1.83 (95% CI: 1.33 to 2.53, I2 = 0%, P = 0.0002) for revascularization, and 1.65 (95% CI: 1.20 to 2.27, I2 = 0%, P = 0.002) for rehospitalization respectively. Subgroup analysis of culprit lesions (CLs) revealed significant differences between DM and non-DM for MACE, MI, revascularization, and stent thrombosis. While non-culprit lesions (NCLs) showed differences for MACE, MI, revascularization, and rehospitalization between the two groups. The rates of MACE, MI, and revascularization are greater in DM than in non-DM patients in terms of all lesions, CLs, and NCLs. Except for CLs, the readmission rate is greater for unstable or progressive angina. Plaque characteristics are similar between patients with and without diabetes. Prospero registration number CRD42023474226.
Ma et al. (Fri,) conducted a meta-analysis in Coronary artery disease (CAD) or high CAD risk (n=4,256). Diabetes mellitus vs. Non-diabetes was evaluated on Major adverse cardiovascular events (MACE) in all CAD lesions (OR 1.82, 95% CI 1.42 to 2.33, p=< 0.00001). Diabetes significantly increased the risk of major adverse cardiovascular events (OR 1.82) compared to non-diabetes in patients with diagnosed or high-risk coronary artery disease.