Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry

Kashif Shaikh; Arslan Ahmed; Heidi Gransar; Ju Hwan Lee; Jonathon Leipsic; Rine Nakanishi; Venkata Alla; Jeroen J. Bax; Benjamin J.W. Chow; Daniel S. Berman; Erica Maffei; Fay Y. Lin; Aiza Ahmad; Augustin DeLago; Gianluca Pontone; Gudrun Feuchtner; Hugo Marques; James K. Min; Joerg Hausleiter; Martin Hadamitzky; Philipp A. Kaufmann; Pedro de Araújo Gonçalves; Ricardo C. Cury; Yong Jin Kim; Hyuk Jae Chang; Ronen Rubinshtein; Todd C. Villines; Yao Lu; Leslee J. Shaw; Stephen Acenbach; Mouaz H. Mouaz; Daniele Andreini; Filippo Cademartiri; Tracy Q. Callister; Matthew J. Budoff

doi:10.1016/j.jdiacomp.2022.108309

Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry

Kashif Shaikh, Arslan Ahmed, Heidi Gransar, Ju Hwan Lee, Jonathon Leipsic, Rine Nakanishi, Venkata Alla, Jeroen J. Bax, Benjamin J.W. Chow, Daniel S. Berman, Erica Maffei, Fay Y. Lin, Aiza Ahmad, Augustin DeLago, Gianluca Pontone, Gudrun Feuchtner, Hugo Marques, James K. Min, Joerg Hausleiter, Martin HadamitzkyPhilipp A. Kaufmann, Pedro de Araújo Gonçalves, Ricardo C. Cury, Yong Jin Kim, Hyuk Jae Chang, Ronen Rubinshtein, Todd C. Villines, Yao Lu, Leslee J. Shaw, Stephen Acenbach, Mouaz H. Mouaz, Daniele Andreini, Filippo Cademartiri, Tracy Q. Callister, Matthew J. Budoff

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

Abstract

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.

Original language	English (US)
Article number	108309
Journal	Journal of Diabetes and its Complications
Volume	36
Issue number	12
DOIs	https://doi.org/10.1016/j.jdiacomp.2022.108309
State	Published - Dec 2022

Keywords

Atherosclerosis
Cardiac CT
Diabetes
Prevention
Statin

ASJC Scopus subject areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Endocrinology

Access to Document

10.1016/j.jdiacomp.2022.108309

Cite this

Shaikh, K., Ahmed, A., Gransar, H., Lee, J. H., Leipsic, J., Nakanishi, R., Alla, V., Bax, J. J., Chow, B. J. W., Berman, D. S., Maffei, E., Lin, F. Y., Ahmad, A., DeLago, A., Pontone, G., Feuchtner, G., Marques, H., Min, J. K., Hausleiter, J., ... Budoff, M. J. (2022). Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry. Journal of Diabetes and its Complications, 36(12), Article 108309. https://doi.org/10.1016/j.jdiacomp.2022.108309

Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry. / Shaikh, Kashif; Ahmed, Arslan; Gransar, Heidi et al.
In: Journal of Diabetes and its Complications, Vol. 36, No. 12, 108309, 12.2022.

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

Shaikh, K, Ahmed, A, Gransar, H, Lee, JH, Leipsic, J, Nakanishi, R, Alla, V, Bax, JJ, Chow, BJW, Berman, DS, Maffei, E, Lin, FY, Ahmad, A, DeLago, A, Pontone, G, Feuchtner, G, Marques, H, Min, JK, Hausleiter, J, Hadamitzky, M, Kaufmann, PA, de Araújo Gonçalves, P, Cury, RC, Kim, YJ, Chang, HJ, Rubinshtein, R, Villines, TC, Lu, Y, Shaw, LJ, Acenbach, S, Mouaz, MH, Andreini, D, Cademartiri, F, Callister, TQ & Budoff, MJ 2022, 'Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry', Journal of Diabetes and its Complications, vol. 36, no. 12, 108309. https://doi.org/10.1016/j.jdiacomp.2022.108309

@article{c147f030916b4cbe927acab55a25011e,

title = "Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry",

abstract = "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.",

keywords = "Atherosclerosis, Cardiac CT, Diabetes, Prevention, Statin",

author = "Kashif Shaikh and Arslan Ahmed and Heidi Gransar and Lee, {Ju Hwan} and Jonathon Leipsic and Rine Nakanishi and Venkata Alla and Bax, {Jeroen J.} and Chow, {Benjamin J.W.} and Berman, {Daniel S.} and Erica Maffei and Lin, {Fay Y.} and Aiza Ahmad and Augustin DeLago and Gianluca Pontone and Gudrun Feuchtner and Hugo Marques and Min, {James K.} and Joerg Hausleiter and Martin Hadamitzky and Kaufmann, {Philipp A.} and {de Ara{\'u}jo Gon{\c c}alves}, Pedro and Cury, {Ricardo C.} and Kim, {Yong Jin} and Chang, {Hyuk Jae} and Ronen Rubinshtein and Villines, {Todd C.} and Yao Lu and Shaw, {Leslee J.} and Stephen Acenbach and Mouaz, {Mouaz H.} and Daniele Andreini and Filippo Cademartiri and Callister, {Tracy Q.} and Budoff, {Matthew J.}",

note = "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: {\textcopyright} 2022",

year = "2022",

month = dec,

doi = "10.1016/j.jdiacomp.2022.108309",

language = "English (US)",

volume = "36",

journal = "Journal of Diabetes and its Complications",

issn = "1056-8727",

publisher = "Elsevier",

number = "12",

}

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.

KW - Atherosclerosis

KW - Cardiac CT

KW - Diabetes

KW - Prevention

KW - Statin

UR - http://www.scopus.com/inward/record.url?scp=85142743642&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85142743642&partnerID=8YFLogxK

U2 - 10.1016/j.jdiacomp.2022.108309

DO - 10.1016/j.jdiacomp.2022.108309

M3 - Article

C2 - 36444796

AN - SCOPUS:85142743642

SN - 1056-8727

VL - 36

JO - Journal of Diabetes and its Complications

JF - Journal of Diabetes and its Complications

IS - 12

M1 - 108309

ER -

Extent of subclinical atherosclerosis on coronary computed tomography and impact of statins in patients with diabetes without known coronary artery disease: Results from CONFIRM registry

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this