Cardiometabolic Risk Is Associated With Atherosclerotic Burden and Prognosis: Results From the Partners Coronary Computed Tomography Angiography Registry

Abstract

OBJECTIVE Our purpose was to evaluate coronary artery disease (CAD) prevalence and prognosis according to cardiometabolic (CM) risk. RESEARCH DESIGN AND METHODS Registry of all patients without prior CAD referred for coronary computed tomography angiography (CCTA). Patients were stratified by groups of increasing CM risk factors (hypertension, low HDL, hypertriglyceridemia, obesity, and dysglycemia) as follows: patients without type 2 diabetes mellitus (T2DM) with fewer than three or with three or more CM risk factors, patients with T2DM not requiring insulin, or those with T2DM requiring insulin. Patients were followed for a primary end point of major adverse cardiovascular events (MACE) composed of unstable angina, late coronary revascularization, myocardial infarction (MI), and cardiovascular mortality. RESULTS Among 1,118 patients (mean age 57 ± 13 years) followed for a mean 3.1 years, there were 21 (1.9%) cardiovascular deaths and 13 (1.2%) MIs. There was a stepwise increase in the prevalence of obstructive CAD with increasing CM risk, from 15% in those without diabetes and fewer than three CM risk factors to as high as 46% in patients with T2DM requiring insulin (P < 0.001). Insulin exposure was associated with the highest adjusted hazard of MACE (hazard ratio 3.29 [95% CI 1.28–8.45], P = 0.01), whereas both T2DM without insulin (1.35, P = 0.3) and three or more CM risk factors without T2DM (1.48, P = 0.3) were associated with a similar rate of MACE. CONCLUSIONS Patients without diabetes who have multiple metabolic risk factors have a similar prognosis and burden of CAD as those with T2DM not requiring insulin. Among patients with diabetes, the need for insulin therapy is associated with greater burden of CAD as well as worse prognosis.