Subclinical Coronary Artery Disease in Asymptomatic Type 2 Diabetes Mellitus: A Cross-Sectional Coronary CT Angiography Study from the Bundelkhand Region, India

Abstract

Background: Type 2 diabetes mellitus (T2DM) accelerates coronary atherosclerosis, which often stays silent until an acute event. We determined the prevalence and severity of subclinical coronary artery disease (CAD) in asymptomatic diabetic patients using coronary CT angiography (CCTA), compared with non-diabetic controls.

Aims/Objectives: The aim of this study was to determine the prevalence and severity of subclinical coronary artery disease in asymptomatic patients with type 2 diabetes mellitus using coronary CT angiography, and to compare the findings with non-diabetic individuals in the Bundelkhand region.

Methodology: In this cross-sectional study, 172 asymptomatic adults (86 T2DM, 86 non-diabetic controls) underwent CCTA with coronary artery calcium (CAC) scoring and CAD-RADS 2.0 classification at a tertiary centre (March 2025–February 2026). Controls were a convenience sample of accompanying attendants or relatives and were not age- or sex-matched; between-group comparisons are therefore unadjusted and descriptive.

Results: Obstructive CAD (CAD-RADS ≥3) occurred in 36/86 diabetics (41.9%) versus 0/86 controls (0.0%; p<0.001). Any coronary plaque was present in 86/86 (100%) versus 26/85 (30.6%). Calcified plaque (40/86, 46.5% vs 1/86, 1.2%), CAC ≥100 (36/86, 41.9% vs 2/86, 2.3%) and multivessel disease (21/86, 24.4% vs 0/86, 0.0%) were commoner in diabetics (all p<0.001). Age was the strongest independent predictor (adjusted OR 1.28/year; p<0.001).

Conclusions: Asymptomatic diabetics carried a high burden of subclinical, frequently obstructive CAD; CCTA enabled early detection and risk stratification. Because controls were substantially younger and unmatched, these between-group differences reflect the combined influence of diabetes and age rather than an age-independent effect of diabetes; the findings are hypothesis-generating and require confirmation in age-matched studies.