Study Finds 47 Percent of Diabetics Show Heart Calcification Progression Despite Normal BP
South Korea: A new study published in BMJ Open has found that maintaining normal systolic blood pressure (SBP) below 120 mmHg significantly slows the progression of coronary artery calcification (CAC)—a marker of early heart disease—in adults without diabetes. However, this protective effect was not observed in those with diabetes, who showed almost twice the rate of CAC progression despite having similar blood pressure control.
The study, led by Dr. Ki-Bum Won and colleagues from Chung-Ang University College of Medicine, Seoul, Republic of Korea, analyzed data from the Korea Initiatives on Coronary Artery Calcification (KOICA) registry. Researchers aimed to assess whether maintaining normal SBP could help reduce CAC progression in asymptomatic, non-diabetic, and diabetic adults with low to intermediate cardiovascular risk.
The retrospective cohort included 10,754 adults with an average age of 51.5 years, of whom 84.5% were male and 14.2% had diabetes. Participants were divided into two groups based on their follow-up SBP readings: those who maintained normal SBP (<120 mmHg) and those with elevated SBP (≥120 mmHg). CAC progression was defined using differences in the square root–transformed coronary artery calcium scores (CACS) between baseline and follow-up scans, with a mean follow-up period of 3.3 years.
The findings revealed a stark difference between groups.
- Diabetic participants showed a 47.3% rate of coronary artery calcification (CAC) progression, compared to 28.4% in non-diabetic participants.
- In non-diabetic individuals, maintaining systolic blood pressure (SBP) below 120 mmHg was significantly associated with slower CAC progression (β = −0.18), even after adjusting for multiple confounding factors.
- This association was not observed in diabetic individuals (β = −0.07), suggesting that diabetes may diminish the cardiovascular benefits of maintaining normal blood pressure.
According to the researchers, maintaining optimal systolic pressure could therefore be an important preventive measure for slowing coronary atherosclerosis progression in individuals without diabetes. In contrast, diabetic patients may require more intensive and tailored strategies to curb CAC buildup and reduce cardiovascular risk.
The study had several limitations, including its retrospective design and potential selection bias, as participants voluntarily attended health check-ups. Differences in CT scanners across centers and a lack of control over medication use were also noted. Furthermore, information on diabetes duration, insulin use, and subtype was unavailable. The researchers also cautioned that their results might not be generalizable beyond Asian populations.
Despite these limitations, the study is one of the first large-scale longitudinal analyses to evaluate the impact of maintaining normal SBP on CAC progression according to diabetes status in an Asian population.
"The findings highlight the critical role of blood pressure management in preventing coronary calcification, particularly in individuals without diabetes," the authors wrote. They emphasized the need for future large-scale randomized trials to confirm these observations and refine therapeutic targets for preventing early coronary artery disease progression.
Reference:
Won K, Choi S, Chun EJ, et al. Association between normal systolic blood pressure maintenance and the risk of coronary artery calcification progression in asymptomatic non-diabetic and diabetic adults: a retrospective cohort study using data from the Korea initiatives on coronary artery calcification registry. BMJ Open 2025;15:e103993. doi: 10.1136/bmjopen-2025-103993
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