P3628Asymptomatic coronary artery disease in type 2 diabetes (T2D), a prospective invasive coronary angiographic (ICA) study with intravascular ultrasound (IVUS) evaluation

Abstract

Background and aims: The prevalence of asymptomatic CAD in T2D is unclear. We investigated 1) the CAD burden cross‐sectionally using IVUS in an asymptomatic T2D‐cohort compared to a reference population without T2D and 2) whether the disease progression of CAD in the T2D cohort, evaluated by ICA, could be modulated with a program to reduce cardiovascular (CV) risk. Methods: Patients with T2D and ≥1 CV risk factor were randomized to 2 years of a hospital based multi‐intervention (MULTI, n=30), or standard care by general physicians (STAND, n=26), with a pre‐planned follow‐up at year 7. ICA was performed at baseline (BL) whereas at year 7 both ICA and IVUS. Angiograms were scored as: grade 0:<25% diameter stenosis (st), 1:<50% st, 2: <75% st, 3: >75% st, 4: occlusion. CAD burden was described conventionally by the extent score (number of segments graded ≥1, adjusted to 16 segments) and severity score (average grade of the diseased segments graded ≥1). IVUS was described by maximal intimal thickness (MIT), percent atheroma volume and total atheroma volume and compared with individuals without T2D and CAD (heart transplant donors) who had IVUS performed 7‐11 weeks post transplantation (n=76). Results: At year 7, atheroma burden was significantly greater (Table) and the age‐stratified prevalence of CAD defined by MIT significantly higher (Figure) in T2D than in the reference population. The 2 year multi‐intervention reduced CV risk factors (HbA1c, blood pressure, lipids) in MULTI, but did not result in long‐term between‐group differences in CAD progression by ICA or in atheroma burden, by IVUS, at year 7 (Table). (Figure presented) Conclusion: Our data suggest that asymptomatic T2D patients have extensive CAD, that progresses over time and is not modulated by a 2 year multiintervention, suggesting a need for more durable residual CV risk management using alternative approaches. (Table presented).