Low-attenuation Coronary Plaque Volume and Cardiovascular Events in Patients with Distinct Metabolic Phenotypes

Background This study aimed to investigate the association between diabetes mellitus (DM), high-risk coronary plaque burden, and risk of cardiovascular outcomes across metabolic phenotypes in patients with suspected coronary artery disease (CAD) who underwent coronary computed tomography angiography (CCTA). Methods We included 530 patients who underwent CCTA. Metabolic syndrome (MetS) was defined as the presence of a visceral adipose tissue area ≥ 100 cm2 in patients with DM (n = 58), or two or more MetS components excluding DM (n = 114). Remaining patients were categorized into non-MetS patients with DM (n = 52) and non-MetS patients without DM (n = 306). CCTA-based high-risk plaque was defined as low-attenuation plaque (LAP) volume > 4 %. Primary endpoint was presence of a major cardiovascular event (MACE), which was defined as a composite of cardiovascular death, acute coronary syndrome, and coronary revascularization. Results Incidence of MACE was highest in the non-MetS with DM group, followed hierarchically by the MetS with DM, MetS without DM, and non-MetS without DM groups. In the multivariable Cox hazard model analysis, DM as a predictor was associated with MACE independent of LAP volume > 4 % (hazard ratio, 2.68; 95% confidence interval, 1.16–6.18; p = 0.02), although MetS did not remain an independent predictor. LAP volume > 4 % remained a predictor of MACE independent of each metabolic phenotype or DM. Conclusions This study demonstrated that DM, rather than MetS, is a predictor of coronary events independent of high-risk plaque volume in patients who underwent CCTA. Clinical Perspective 1. What Is New? 2. What Are the Clinical Implications? ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement none ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Fujiikai Kashibaseiki Hospital Institutional Review Board I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data is available from the corresponding author by reasonable request