# Risk factors and the CCTA application in patients with vulnerable coronary plaque in type 2 diabetes: a retrospective study

## TL;DR

This study identifies risk factors for vulnerable coronary plaques in type 2 diabetes patients and shows that CCTA is effective in detecting these plaques.

## Contribution

The study introduces TIR and lipid levels as key predictors of vulnerable coronary plaques in T2DM patients and validates CCTA's diagnostic accuracy against IVUS.

## Key findings

- Higher TIR and HDL-C levels are associated with lower risk of vulnerable coronary plaques in T2DM patients.
- Triglyceride levels are linked to a higher risk of vulnerable coronary plaques in T2DM patients.
- CCTA demonstrates high sensitivity and specificity in identifying vulnerable coronary plaques, correlating well with IVUS.

## Abstract

Diabetes is an independent risk factor for cardiovascular disease. The purpose of this study was to identify the risk factors for vulnerable coronary plaques (VCPs), which are associated with adverse cardiovascular events, and to determine the value of coronary CT angiography (CCTA) in patients with type 2 diabetes mellitus (T2DM) and VCPs.

Ninety-eight T2DM patients who underwent CCTA and intravascular ultrasound (IVUS) were retrospectively included and analyzed. The patients were grouped and analyzed according to the presence or absence of VCPs.

Among the patients with T2DM, time in range [TIR {the percentage of time blood glucose levels were in the target range}] (OR = 0.93, 95% CI = 0.89–0.96; P < 0.001) and the high-density lipoprotein-cholesterol (HDL-C) concentration (OR = 0.24, 95% CI = 0.09–0.63; P = 0.04) were correlated with a lower risk of VCP, but the triglycerides (TG) concentration was correlated with a higher risk of VCP (OR = 1.79, 95% CI = 1.01–3.18; P = 0.045). The area under the receiver operator characteristic curve (AUC) of TIR, and HDL-C and TG concentrations were 0.76, 0.73, and 0.65, respectively. The combined predicted AUC of TIR, and HDL-C and TG concentrations was 0.83 (P < 0.05). The CCTA sensitivity, specificity, false-negative, and false-positive values for the diagnosis of VCP were 95.74%, 94.12%, 4.26%, and 5.88%, respectively. The identification of VCP by CCTA was positively correlated with IVUS (intraclass correlation coefficient [ICC] = 0.90).

The TIR and HDL-C concentration are related with lower risk of VCP and the TG concentration was related with higher risk of VCP in patients with T2DM. In clinical practice, TIR, HDL-C and TG need special attention in patients with T2DM. The ability of CCTA to identify VCP is highly related to IVUS findings.

The online version contains supplementary material available at 10.1186/s12872-024-03717-1.