Asymptomatic Coronary Artery Disease (CAD) in a Norwegian Cohort with Type 2 Diabetes (T2D)—A Prospective Invasive Coronary Angiographic (ICA) Study

Effective treatment strategies to reduce the CAD burden in T2D are needed. We investigated whether progression of CAD, evaluated by ICA, could be modulated with a hospital-based multi-intervention (MULTI) to reduce cardiovascular (CV) risk. Patients with T2D and ≥ 1 CV risk factor (n=56, 21% women, age/T2D duration 57.9±7.9/5.8±5.6 years, HbA1c 7.4±1.6%, systolic BP 139±19 mmHg, LDL-cholesterol 2.8±0.9 mmol/L) were randomized to 2 years of MULTI (n=30), or standard care (STAND) by general physicians (n=26), with a pre-planned follow-up at year 7. ICA was performed at baseline (BL) and year 7. At BL 21 (36%) had no CAD, 17 (29%) wall changes, 4 (7%) 25-50% stenosis and 14 (24%) >50% stenosis. Angiograms were scored as: grade 0:<25% stenosis (st), 1:<50% st, 2: <75% st, 3: >75% st, 4: occlusion. CAD burden was described by the extent score (sc) (number of segments graded ≥1, adjusted to 16 segments) and severity sc (average gr of the diseased segments graded ≥1). After 2 years of intervention, CV risk factors in MULTI (HbA1c, systolic BP, LDL-cholesterol) were reduced, without between-group differences in CAD progression at year 7 (Table). Our data indicate that asymptomatic T2D patients have extensive CAD that increases over time and is not modulated by a 2-year multi-intervention. This suggests a need for more durable CV risk management using alternative approaches.