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Diabetes, hypertension, dyslipidemia increase risk for developing soft arterial plaque
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Diabetes, high blood pressure and elevated cholesterol all raise the risk for developing increased amounts of noncalcified arterial plaque in low-risk, asymptomatic adults, according to research in Radiology.
In an ongoing prospective study, researchers used coronary CT angiography (CTA) to measure total and noncalcified coronary artery plaque, highlighting the benefits of a noninvasive, ultrasound-like technique in determining risk for coronary artery disease.
“CTA can now readily evaluate atherosclerosis in people who do not have symptoms,” David A. Bluemke, MD, PhD, of the NIH Clinical Center, told Endocrine Today. “Beyond calcium score, CTA can find noncalcified/soft plaque in the arteries.”
David A. Bluemke
Bluemke and colleagues at other institutions analyzed data from 202 adults aged 55 years or older (36% women; mean age, 65.5 years) who were asymptomatic and eligible for statin therapy. Researchers performed coronary CTA to measure arterial wall thickness and plaque in all epicardial coronary arteries larger than 2 mm in diameter. The total plaque index (calcified plus noncalcified plaque) was defined as plaque volume divided by vessel length.
The noncalcified plaque index was associated with higher systolic BP (beta = 0.8 mm²/10 mm Hg; P = .03), diabetes (beta = 4.47 mm²; P = .03) and elevated LDL cholesterol level (beta = 0.04 mm²/mg/dL; P = .02).
The total coronary plaque index also was greater in men than in women after adjusting for all risk factors, according to researchers.
“Rupture of ‘soft’ or noncalcified plaque in the arteries is thought to be directly related to heart attack,” Bluemke said. “In asymptomatic individuals, CTA detected more soft plaque when those individuals had elevated LDL cholesterol, elevated BP and diabetes.”
More research is needed to determine whether CTA can show a change in soft plaque after a patient begins statin therapy, he said.
“We think it is likely that statins help some people to have less plaque in their arteries, while others continue to form coronary plaque,” Bluemke said. “If plaque continues to increase while on therapy, CTA could provide a rationale to increase or change the treatment in order to better treat the plaque.” - by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Roger S. Blumenthal, MD
To date, registries have not shown a clear advantage of doing CTA instead of noncontrast CT for coronary artery calcium scoring in asymptomatic individuals. The event rate in middle-aged and older adults without exertional symptoms is extremely low over the next decade. Further research will help us determine if there is a clear prognostic benefit in identifying noncalcified plaque in certain groups of individuals such as those with a family history of premature CHD or those with HIV. For now, we should limit clinical use of CTA to symptomatic individuals.
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