Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial

Zuzanna M. Gebert; Jacek Kwiecinski; Jonathan R. Weir-Mccall; Philip D. Adamson; Nicholas L. Mills; Giles Roditi; Edwin J.R. van Beek; Edward D. Nicol; Daniel S. Berman; Piotr J. Slomka; Marc R. Dweck; Damini Dey; David E. Newby; Michelle C. Williams

doi:10.1016/j.jcct.2024.12.083

Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial

Zuzanna M. Gebert, Jacek Kwiecinski, Jonathan R. Weir-Mccall, Philip D. Adamson, Nicholas L. Mills, Giles Roditi, Edwin J.R. van Beek, Edward D. Nicol, Daniel S. Berman, Piotr J. Slomka, Marc R. Dweck, Damini Dey, David E. Newby, Michelle C. Williams^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background
Diabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial.
Methods
Coronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed.
Results
Images of 1769 patients were assessed (56% male, 58±9 years). Diabetes mellitus was present in 196 (11%) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p<0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p<0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p=0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95% confidence interval 1.09 to 3.17, p=0.024).
Conclusion
Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.

Original language	English
Journal	Journal of Cardiovascular Computed Tomography
DOIs	https://doi.org/10.1016/j.jcct.2024.12.083
Publication status	Published - 9 Jan 2025

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Gebert, Z. M., Kwiecinski, J., Weir-Mccall, J. R., Adamson, P. D., Mills, N. L., Roditi, G., van Beek, E. J. R., Nicol, E. D., Berman, D. S., Slomka, P. J., Dweck, M. R., Dey, D., Newby, D. E., & Williams, M. C. (2025). Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial. Journal of Cardiovascular Computed Tomography. https://doi.org/10.1016/j.jcct.2024.12.083

@article{3fbd5c4f9e8d4f5792291a82340e53ab,

title = "Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial",

abstract = "BackgroundDiabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial.MethodsCoronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed. ResultsImages of 1769 patients were assessed (56% male, 58±9 years). Diabetes mellitus was present in 196 (11%) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p<0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p<0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p=0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95% confidence interval 1.09 to 3.17, p=0.024). Conclusion Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.",

author = "Gebert, {Zuzanna M.} and Jacek Kwiecinski and Weir-Mccall, {Jonathan R.} and Adamson, {Philip D.} and Mills, {Nicholas L.} and Giles Roditi and {van Beek}, {Edwin J.R.} and Nicol, {Edward D.} and Berman, {Daniel S.} and Slomka, {Piotr J.} and Dweck, {Marc R.} and Damini Dey and Newby, {David E.} and Williams, {Michelle C.}",

year = "2025",

month = jan,

day = "9",

doi = "10.1016/j.jcct.2024.12.083",

language = "English",

journal = "Journal of Cardiovascular Computed Tomography",

issn = "1934-5925",

publisher = "Elsevier Inc.",

}

Gebert, ZM, Kwiecinski, J, Weir-Mccall, JR, Adamson, PD, Mills, NL, Roditi, G, van Beek, EJR, Nicol, ED, Berman, DS, Slomka, PJ, Dweck, MR, Dey, D, Newby, DE & Williams, MC 2025, 'Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial', Journal of Cardiovascular Computed Tomography. https://doi.org/10.1016/j.jcct.2024.12.083

TY - JOUR

T1 - Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial

AU - Gebert, Zuzanna M.

AU - Kwiecinski, Jacek

AU - Weir-Mccall, Jonathan R.

AU - Adamson, Philip D.

AU - Mills, Nicholas L.

AU - Roditi, Giles

AU - van Beek, Edwin J.R.

AU - Nicol, Edward D.

AU - Berman, Daniel S.

AU - Slomka, Piotr J.

AU - Dweck, Marc R.

AU - Dey, Damini

AU - Newby, David E.

AU - Williams, Michelle C.

PY - 2025/1/9

Y1 - 2025/1/9

N2 - BackgroundDiabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial.MethodsCoronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed. ResultsImages of 1769 patients were assessed (56% male, 58±9 years). Diabetes mellitus was present in 196 (11%) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p<0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p<0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p=0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95% confidence interval 1.09 to 3.17, p=0.024). Conclusion Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.

AB - BackgroundDiabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial.MethodsCoronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed. ResultsImages of 1769 patients were assessed (56% male, 58±9 years). Diabetes mellitus was present in 196 (11%) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p<0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p<0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p=0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95% confidence interval 1.09 to 3.17, p=0.024). Conclusion Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.

U2 - 10.1016/j.jcct.2024.12.083

DO - 10.1016/j.jcct.2024.12.083

M3 - Article

SN - 1934-5925

JO - Journal of Cardiovascular Computed Tomography

JF - Journal of Cardiovascular Computed Tomography

ER -

Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial

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