Intracoronary ultrasound examinations reveal significantly more advanced coronary atherosclerosis in people with type 1 diabetes than in age- and sex-matched non-diabetic controls

Abstract

Aims/hypothesis: The extent of coronary atherosclerosis is significantly more advanced in symptomatic type 1 diabetes patients than in symptomatic non-diabetic patients. Whether this difference exists between asymptomatic individuals with diabetes and controls is not documented. In vivo imaging techniques allow quantification of the difference at a preclinical stage. Methods: The degree of coronary atherosclerosis in early onset type 1 diabetes patients without symptoms of cardiovascular disease was compared with that of age- and sex-matched controls. Intracoronary ultrasound (IVUS) examinations were performed to determine the degree of atherosclerosis. The mean age of the patients was 43 years (35–58), they had a mean duration of disease of 30 (23–39) years and the diagnosis of type 1 diabetes was made at a mean age of 12.5 years. The controls were people with transplanted hearts; donors were sex- and age-matched and had a mean age of 43 (35–58) years. Results: The degree of subclinical coronary atherosclerosis was significantly more severe in type 1 diabetes patients than in controls. This was the case for all parameters measured. The mean plaque area was ≥ 40% in 71% (54/76) of diabetic arteries as opposed to 33% (25/76) of arteries from controls (p<0.0001). The mean plaque thickness was 0.59±0.38 mm vs. 0.44±0.30mm in controls (p<0.0001). The mean lumen area was 8.6±3.8mm2 in type 1 diabetes and 12.1±4.3 mm2 in controls (p<0.0001). Conclusions/interpretation: Asymptomatic individuals with type 1 diabetes have significantly more advanced sub-clinical coronary atherosclerosis than controls. Coronary atherosclerosis in type 1 diabetes develops at an early age.