Abstract Background Type 2 diabetes mellitus (T2DM) is a chronic and progressive condition associated with significant cardiovascular risk. Its pathophysiology evolves over time, and risk stratification should consider factors such as age at diagnosis, glycemic control, and lipid profile. Incorporating such data could allow for a more accurate risk definition in this population and potentially support more informed decisions regarding the choice of the most appropriate diagnostic test, the intensity and nature of follow-up, and the optimization of medical therapy. Purpose The aim of this study was to evaluate the utility of the SCORE2-Diabetes model in assessing the presence, severity, and type of coronary artery disease in patients with type 2 diabetes. Methods A retrospective analysis was conducted on 104 patients with T2DM who underwent coronary computed tomography angiography (CTCA). For each patient, the SCORE2-D value was calculated, and coronary findings—including plaque presence, plaque composition, and degree of stenosis—were evaluated in relation to SCORE2-D categories. Results Higher SCORE2-D values were significantly associated with the presence of coronary plaques (p 0.01). Differences in plaque composition were observed, with lipid-rich and mixed plaques being more frequent among patients with higher SCORE2-D scores (p 0.01). The severity of coronary stenosis also increased progressively with rising SCORE2-D categories, with moderate-to-severe stenosis most prevalent in the very high-risk group (p 0.05). In addition, a distribution analysis revealed a distinct pattern in clinical management across SCORE2-D risk classes. Among patients categorized as very high risk, 62% underwent invasive coronary angiography (ICA) or were referred for additional functional testing. In contrast, patients in the low and moderate risk categories were more frequently managed with conservative strategies, including clinical follow-up and optimization of medical therapy. These findings underline the potential of SCORE2-D not only in detecting coronary atherosclerosis but also in guiding clinical decision-making pathways. Conclusions These findings support the clinical relevance of SCORE2-D in estimating the probability and characteristics of coronary artery disease in patients with T2DM. The model showed significant correlations with anatomical evidence of atherosclerosis, plaque composition, and stenosis severity, suggesting its potential utility in guiding diagnostic strategies.Graphical abstract
Mollace et al. (Thu,) studied this question.