Type 2 diabetes linked to nearly a decade of extra coronary artery aging on CT scans

People referred for a coronary CT angiography scan who had type 2 diabetes carried substantially more coronary artery disease than those without the condition, according to a retrospective cohort study published in Cardiovascular Diabetology. Among 4,211 consecutive individuals scanned for suspected coronary artery disease between January 2022 and December 2023, 341 people, or 8.1 percent, had type 2 diabetes. Those with diabetes were far more likely to have detectable coronary artery disease, at 86 percent versus 68 percent, and obstructive disease, at 36 percent versus 20 percent, and the differences were statistically significant.

The study went beyond simply noting whether plaque was present. The researchers quantified the extent of atherosclerosis using the segment involvement score, a count of how many of the coronary artery segments evaluated contained plaque. They also separately counted segments holding non-calcified plaque and those holding calcified plaque, since plaque composition carries different implications for how disease develops and progresses.

After adjustment in multivariable regression models, type 2 diabetes remained independently associated with coronary artery disease, with an odds ratio of 2.03, and with obstructive coronary artery disease, with an odds ratio of 1.72. Diabetes was also linked to a greater segment involvement score, with a rate ratio of 1.25, and to more segments containing non-calcified plaque, with a rate ratio of 1.25, and calcified plaque, with a rate ratio of 1.34. In other words, the association held for both plaque types rather than being driven by one component alone.

One of the most striking results came from translating the plaque burden difference into an age equivalent. At the median age of 59 years, the higher segment involvement score associated with type 2 diabetes corresponded to an age-equivalent difference of 9.9 years, with a 95 percent simulation interval of 6.2 to 15.1 years. Put simply, on average the coronary arteries of people with diabetes in this cohort resembled those of people nearly a decade older.

The researchers also explored how measures of glycemic control and disease duration related to the scan findings, although they framed these as exploratory analyses. Higher glycated hemoglobin A1c was associated with a greater number of segments containing non-calcified plaque, with a rate ratio of 1.08 per 1 percent increase in HbA1c. Longer diabetes duration was associated with obstructive coronary artery disease, with an odds ratio of 1.21 per 5-year increase. These associations suggest that both current glycemic levels and the length of time someone has lived with diabetes may relate to the coronary picture, though the analyses were exploratory and cannot establish cause and effect.

The study has clear limitations that shape how the findings should be read. It was retrospective and included only people who were already referred for CCTA because of suspected coronary artery disease, so the results describe this referred population rather than the general population or people with diabetes who are asymptomatic. Associations reported in the study, including the age-equivalent comparison, describe relationships observed in the data and do not demonstrate that diabetes caused the plaque burden differences. The analyses of HbA1c and diabetes duration were explicitly labeled exploratory.

Within those limits, the authors argue the work offers a detailed characterization of the coronary atherosclerotic phenotype linked to type 2 diabetes. By separately quantifying calcified and non-calcified plaque across coronary segments, the study indicates that the diabetes association is not confined to a single plaque type. The finding that higher HbA1c was associated specifically with more segments containing non-calcified plaque adds a glycemic dimension to that picture, consistent with the study’s stated key research question about how diabetes, glycemic control and diabetes duration relate to plaque extent and composition.

The authors suggest the findings may provide further insight into the coronary atherosclerotic phenotype of type 2 diabetes for clinical practice. The paper, published open access on 23 October 2026, was authored by Willem R. van de Vijver, Victor A. Verpalen, Nick S. Nurmohamed and colleagues, with Michiel M. Winter among the senior authors. For people living with type 2 diabetes, the study’s message is that the coronary artery differences associated with the condition are visible on CT angiography not only as a higher likelihood of disease but as a measurably broader spread of plaque across the coronary tree, amounting on average to arteries that look close to ten years older at the study’s median age.

Subject of Research: Coronary atherosclerosis extent and composition on CT angiography in individuals with and without type 2 diabetes

Article Title: Coronary atherosclerosis on coronary CT angiography in individuals with and without type 2 diabetes

Article References: van de Vijver, W. R., Verpalen, V. A., Nurmohamed, N. S., Hennecken, J., Dijkstra, T. N., Gommers, M., Bosch, I. T., Somsen, G. A., Tulevski, I. I., del Villar, C. P., Hanssen, N. M. J., Takx, R. A. P., Henriques, J. P. S., Planken, R. N., Claessen, B. E. P. M., & Winter, M. M. (2026). Coronary atherosclerosis on coronary CT angiography in individuals with and without type 2 diabetes. Cardiovascular Diabetology. https://doi.org/10.1186/s12933-026-03413-8

Image Credits: AI Generated

DOI: 10.1186/s12933-026-03413-8

Keywords: type 2 diabetes, coronary CT angiography, coronary atherosclerosis, segment involvement score, non-calcified plaque, calcified plaque, HbA1c, diabetes duration, obstructive coronary artery disease, cardiovascular imaging, Coronary, atherosclerosis