Background: Diabetes mellitus (DM) plays a key role in the
pathophysiology of metabolic syndrome (MetS). This study aimed to investigate the
association among DM, low-attenuation plaque (LAP) volume, and cardiovascular
outcomes across metabolic phenotypes in patients with suspected coronary artery
disease (CAD) who underwent coronary computed tomography angiography (CCTA).
Methods: We included 530 patients who underwent CCTA. MetS was defined
as the presence of a visceral adipose tissue area 100 cm in
patients with DM (n = 58) or two or more MetS components excluding DM (n = 114).
The remaining patients were categorised as non-MetS patients with DM (n = 52) or
without DM (n = 306). A CCTA-based high-risk plaque was defined as a LAP volume
of 4%. The primary endpoint was the presence of a major cardiovascular event
(MACE), which was defined as a composite of cardiovascular death, acute coronary
syndrome, and coronary revascularization. Results: The incidence of MACE
was the highest in the non-MetS with DM group, followed hierarchically by the
MetS with DM, MetS without DM, and non-MetS without DM groups. In the
multivariable Cox hazard model analysis, DM as a predictor was associated with
MACE independent of LAP volume 4% (hazard ratio, 2.68; 95% confidence
interval, 1.16–6.18; p = 0.02), although MetS did not function as an
independent predictor. A LAP volume 4% functioned as a predictor of MACE,
independent of each metabolic phenotype or DM. Conclusions: This study
demonstrated that DM, rather than MetS, is a predictor of coronary events
independent of high-risk plaque volume in patients who underwent CCTA.