Journal of Diabetes and Its Complications · Mar 23, 2026

Peri-coronary inflammation and coronary microcalcification activity in subjects with diabetes mellitus; a cross-sectional analysis

By Smith B, Bellinge B, Francis RJ et al.

INTRODUCTION: Coronary microcalcification activity (CMA) independently prognosticates cardiovascular disease risk. The relationship between dysfunctional peri-coronary adipose tissue (PCAT), a measure of local inflammation, and CMA has not been characterised in people with diabetes mellitus. METHODS: Subjects with diabetes mellitus underwent 18F-Sodium Fluoride (18F-NaF) Positron Emission Tomography (PET) imaging and Computed Tomography (CT) coronary calcium score (CCS) imaging. Non-contrast PCAT (NC-PCAT) was quantified using the CT-value (Hounsfield Units (HU)) of the tissue adjacent to the right coronary artery. RESULTS: In total, 151 subjects were studied (mean age 65.4 ± 6.9, male 65.6%). Male sex (OR 2.44, 95% CI [1.17-5.05], p = 0.017), statin use (2.75 [1.09-6.89], p = 0.031), any oral antihyperglycemic use (0.43 [0.19-0.97], p = 0.043), eGFR (1.03 [1.00-1.05], p = 0.037) and the CT CCS (per 100 Agatston units, 1.17 [1.08-1.27], p < 0.001) were associated with increasing CMA. Furthermore, the NC-PCAT (per 1 HU) was positively and independently associated with increasing CMA (1.04 [1.01-1.07], p = 0.022). An NC-PCAT higher than -68.3 (N = 21) was specific for triple-vessel CMA (specificity 90%, sensitivity 47%). CONCLUSION: An elevated NC-PCAT value is independently associated with a greater CMA in people with diabetes mellitus. Further research is required to determine if NC-PCAT measures provide CVD risk stratification beyond the CT CCS.

doi.org/10.1016/j.jdiacomp.2026.109316Open accessPubMed 41886838Biomarkers