Study Links Metabolic Syndrome to Adverse Coronary Plaque Profiles in T2DM
China: A new study has found that metabolic syndrome (MS) independently contributes to more severe and unfavorable coronary artery plaque characteristics in patients with type 2 diabetes mellitus (T2DM). These include higher rates of mixed, noncalcified, and nonobstructive plaques, as well as spotty calcification and extensive plaque burden.
The findings published in Frontiers in Endocrinology emphasize the importance of early detection and control of MS components to reduce cardiovascular risk in this vulnerable population.
The research, led by Yu-shan Zhang and colleagues from the Department of Radiology, West China Hospital, Sichuan University, assessed the effect of MS on coronary atherosclerotic plaques in patients with T2DM. Using coronary computed tomography angiography (CCTA), the investigators analyzed plaque type, stenosis severity, high-risk plaque features, and measures of plaque extent, such as segment involvement score (SIS) and segment stenosis score (SSS). A total of 2,431 patients with T2DM who underwent CCTA between January 2015 and February 2022 were retrospectively enrolled and grouped based on the presence or absence of MS.
The key findings of the study were as follows:
- 61.5% of the cohort (1,496 patients) had metabolic syndrome (MS).
- Patients with MS showed a higher prevalence of noncalcified and mixed plaques.
- They also had a greater occurrence of nonobstructive stenosis.
- SIS (Segment Involvement Score) and SSS (Segment Stenosis Score) values were significantly higher in patients with MS.
- The number of MS components correlated directly with worsening plaque features, including higher proportions of patients with noncalcified or mixed plaques, SIS ≥4, and SSS ≥7.
- Multivariate logistic regression confirmed MS as an independent predictor of adverse plaque profiles.
- MS was associated with higher odds of noncalcified plaques (OR=1.232).
- MS increased the likelihood of mixed plaques (OR=1.307).
- MS was linked with more nonobstructive stenosis (OR=1.615).
- Patients with MS had greater odds of SIS ≥4 (OR=1.529).
- MS was associated with SSS ≥7 (OR=1.387).
- MS significantly increased the risk of spotty calcification (OR=1.870).
- All associations remained significant even after adjusting for potential confounding factors.
The study concludes that metabolic syndrome plays a pivotal role in shaping the coronary artery disease profile of patients with T2DM. Among the individual components of MS, hypertension appeared to exert the greatest influence on coronary atherosclerosis in this group. This suggests that aggressive blood pressure management, along with broader MS control, could be essential in slowing plaque progression and reducing future cardiovascular events.
Despite its strengths, the authors acknowledged several limitations. The cross-sectional design prevents causal inference, and certain confounders, such as detailed lipid-related variables, were not captured. Moreover, the single-center setting and the exclusively Chinese patient population may limit generalizability. Nonetheless, the large sample size and comprehensive imaging analysis lend strong support to the conclusions.
Overall, this study highlights the pressing need for systematic screening and early intervention for metabolic syndrome in individuals with type 2 diabetes. By targeting modifiable risk factors such as hypertension, obesity, and dyslipidemia, clinicians may be able to reduce coronary plaque burden and improve long-term cardiovascular outcomes in this high-risk group.
Reference:
Zhang, Y., Shi, R., Jiang, Y., Gao, Y., Wang, J., Li, Y., & Yang, Z. (2025). Effect of metabolic syndrome on coronary artery atherosclerotic plaque in type 2 diabetes mellitus patients. Frontiers in Endocrinology, 16, 1595475. https://doi.org/10.3389/fendo.2025.1595475
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