TY - JOUR
T1 - Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease
T2 - Results from CONFIRM registry
AU - Shaikh, Kashif
AU - Ahmed, Arslan
AU - Gransar, Heidi
AU - Lee, Ju Hwan
AU - Leipsic, Jonathon
AU - Nakanishi, Rine
AU - Alla, Venkata
AU - Bax, Jeroen J.
AU - Chow, Benjamin J.W.
AU - Berman, Daniel S.
AU - Maffei, Erica
AU - Lin, Fay Y.
AU - Ahmad, Aiza
AU - DeLago, Augustin
AU - Pontone, Gianluca
AU - Feuchtner, Gudrun
AU - Marques, Hugo
AU - Min, James K.
AU - Hausleiter, Joerg
AU - Hadamitzky, Martin
AU - Kaufmann, Philipp A.
AU - de Araújo Gonçalves, Pedro
AU - Cury, Ricardo C.
AU - Kim, Yong Jin
AU - Chang, Hyuk Jae
AU - Rubinshtein, Ronen
AU - Villines, Todd C.
AU - Lu, Yao
AU - Shaw, Leslee J.
AU - Acenbach, Stephen
AU - Mouaz, Mouaz H.
AU - Andreini, Daniele
AU - Cademartiri, Filippo
AU - Callister, Tracy Q.
AU - Budoff, Matthew J.
N1 - Funding Information:
Declaration of competing interest: J.K.M. receives funding from the Dalio Foundation , National Institutes of Health , and GE Healthcare , serves on the scientific advisory board of Arineta and GE Healthcare and has an equity interest in Cleerly. Matthew Budoff receives grant support from the National Institutes of Health and General Electric . D.S.B. receives a research grant from Heartflow and software royalties from Cedars-Sinai Medical Center. Gianluca Pontone has a research grant and/or honorarium as speaker from GE , Bracco , Bayer , Medtronic , and Heartflow . All other authors have no relationships relevant to the contents of this paper to disclose.
Funding Information:
Declaration of competing interest: J.K.M. receives funding from the Dalio Foundation, National Institutes of Health, and GE Healthcare, serves on the scientific advisory board of Arineta and GE Healthcare and has an equity interest in Cleerly. Matthew Budoff receives grant support from the National Institutes of Health and General Electric. D.S.B. receives a research grant from Heartflow and software royalties from Cedars-Sinai Medical Center. Gianluca Pontone has a research grant and/or honorarium as speaker from GE, Bracco, Bayer, Medtronic, and Heartflow. All other authors have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2022
PY - 2022/12
Y1 - 2022/12
N2 - Background: Absence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has not been evaluated. Methods: CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multi-center Registry) study enrolled consecutive adults 18 years of age between 2005 and 2009 who underwent 364-detector row CCTA for suspected CAD. The long-term registry includes data on 12,086 subjects who underwent CCTA at 17 centers in 9 countries. In this sub-study of CONFIRM registry, patients with diabetes mellitus (DM) and without diabetes mellitus with normal CCTA or non-obstructive plaque (<50 % diameter stenosis) for whom data on baseline statin use was available were included. CAC score was calculated using Agatston score. The magnitude of non-obstructive coronary artery disease on CCTA was quantified using segment involvement score (SIS). Primary outcome was major cardiovascular events (MACE) which included all-cause mortality, myocardial infarction, and target vessel re-vascularization. Results: A total of 7247 patients (Mean age 56.8 years) with a median follow up of 5 years were included. For DM patients, baseline statin therapy significantly reduced MACE for patients with CAC ≥100 (HR: 0.24; 95 % CI 0.07–0.87; p = 0.03) and SIS≥3 (HR: 0.23; 95 % CI 0.06–0.83; p = 0.024) compared to those not on statin therapy. Among Diabetics with lower CAC (<100) and SIS (≤3) scores, MACE was similar in statin and non-statin groups. In contrast, among non-DM patients, MACE was similar in statin and no statin groups irrespective of baseline CAC (1–99 or ≥100) and SIS. Conclusion: In this large multicenter cohort of patients, the presence and extent of subclinical atherosclerosis as assessed by CAC and SIS identified patients most likely to derive benefit from statin therapy.
AB - Background: Absence of subclinical atherosclerosis is considered safe to defer statin therapy in general population. However, impact of statins on atherosclerotic cardiovascular disease in patients with diabetes stratified by coronary artery calcium (CAC) scores and extent of non-obstructive CAD on coronary computed tomography angiography (CCTA) has not been evaluated. Methods: CONFIRM (Coronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multi-center Registry) study enrolled consecutive adults 18 years of age between 2005 and 2009 who underwent 364-detector row CCTA for suspected CAD. The long-term registry includes data on 12,086 subjects who underwent CCTA at 17 centers in 9 countries. In this sub-study of CONFIRM registry, patients with diabetes mellitus (DM) and without diabetes mellitus with normal CCTA or non-obstructive plaque (<50 % diameter stenosis) for whom data on baseline statin use was available were included. CAC score was calculated using Agatston score. The magnitude of non-obstructive coronary artery disease on CCTA was quantified using segment involvement score (SIS). Primary outcome was major cardiovascular events (MACE) which included all-cause mortality, myocardial infarction, and target vessel re-vascularization. Results: A total of 7247 patients (Mean age 56.8 years) with a median follow up of 5 years were included. For DM patients, baseline statin therapy significantly reduced MACE for patients with CAC ≥100 (HR: 0.24; 95 % CI 0.07–0.87; p = 0.03) and SIS≥3 (HR: 0.23; 95 % CI 0.06–0.83; p = 0.024) compared to those not on statin therapy. Among Diabetics with lower CAC (<100) and SIS (≤3) scores, MACE was similar in statin and non-statin groups. In contrast, among non-DM patients, MACE was similar in statin and no statin groups irrespective of baseline CAC (1–99 or ≥100) and SIS. Conclusion: In this large multicenter cohort of patients, the presence and extent of subclinical atherosclerosis as assessed by CAC and SIS identified patients most likely to derive benefit from statin therapy.
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U2 - 10.1016/j.jdiacomp.2022.108309
DO - 10.1016/j.jdiacomp.2022.108309
M3 - Article
C2 - 36444796
AN - SCOPUS:85142743642
VL - 36
JO - Journal of Diabetes and its Complications
JF - Journal of Diabetes and its Complications
SN - 1056-8727
IS - 12
M1 - 108309
ER -