ACE-I or ARB use was not associated with lower pericoronary adipose tissue attenuation compared to non-users in patients with T2DM and coronary atherosclerosis (-72.1 vs -71.7 HU; p=0.722).
Observational (n=223)
No
Does ACE-I or ARB treatment reduce pericoronary adipose tissue attenuation in patients with type 2 diabetes mellitus and coronary atherosclerosis?
ACE-I/ARB treatment was not associated with lower coronary inflammation (assessed by PCAT attenuation) in T2DM patients with coronary atherosclerosis, though a benefit was seen in those with GFR < 90 mL/min.
Absolute Event Rate: -72.1% vs -71.7%
p-value: p=0.722
Background: In patients with type 2 diabetes mellitus (T2DM), angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are first-line antihypertensive treatments with important cardiovascular benefits, but their impacts on coronary-specific inflammation are unknown. Pericoronary adipose tissue (PCAT) attenuation, as assessed by coronary computed tomography angiography (CCTA), serves as a specific biomarker for coronary inflammation. Here, we aim to assess whether treatment with ACE-I or ARB is correlated with lower PCAT attenuation. Methods: In this retrospective observational study, we analyzed 223 patients with T2DM and coronary atherosclerosis who underwent CCTA from 1 January 2017 to 1 September 2024 at our institution. PCAT attenuation was measured in the proximal right coronary artery. Propensity score matching and multivariate linear regression analyses were performed for comparisons. Results: Of the 223 patients (mean age of 64.9 ± 8.8 years, 69.1% male), 122 patients were on ACE-I or ARB (ACE-I/ARB). ACE-I/ARB users had similar PCAT attenuation as their counterparts after propensity score matching (−72.1 ± 7.5 and −71.7 ± 8.1 HU, respectively; p = 0.722). Subgroup analysis in patients with glomerular filtration rate (GFR) < 90 mL/min revealed lower PCAT attenuation in ACE-I/ARB users (−74.8 ± 6.6 vs. −71.4 ± 7.1 HU; p = 0.038), with a significant interaction between these two factors in the multivariate analysis (p = 0.047). Other antihypertensive treatments (beta blockers, dihydropyridine calcium channel blockers, and thiazides) were not linked with lower coronary inflammation. Conclusions: In T2DM patients with coronary atherosclerosis, we did not find an association between ACE-I/ARB treatment and lower coronary inflammation as defined by PCAT attenuation, although such a relationship may exist in those with reduced GFRs.
Wu et al. (Tue,) conducted a observational in Type 2 diabetes mellitus and coronary atherosclerosis (n=223). Angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor blockers (ARBs) vs. Non-users was evaluated on Pericoronary adipose tissue (PCAT) attenuation (p=0.722). ACE-I or ARB use was not associated with lower pericoronary adipose tissue attenuation compared to non-users in patients with T2DM and coronary atherosclerosis (-72.1 vs -71.7 HU; p=0.722).