Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are not independently associated with lower pericoronary adipose tissue attenuation on CT in patients with type 2 diabetes mellitus.

Background: In patients with type 2 diabetes mellitus (T2DM), angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) are first-line antihypertensive treatments with important cardiovascular benefits and their impact on coronary-specific inflammation is unknown. Pericoronary adipose tissue (PCAT) attenuation, as assessed by coronary computed tomography angiography (CCTA), serves as specific biomarker for coronary inflammation and we aim to assess whether treatment with ACE-I or ARB is correlated with lower PCAT attenuation. Methods: In this retrospective observational study, we analyzed 223 patients with T2DM and coronary atherosclerosis who underwent CCTA between 1/1/2017 through 9/1/2024 at our institution. PCAT attenuation was measured in the proximal right coronary artery. Multivariate linear and logistics regression analyses were performed. Results: Of the 223 patients (mean age 64.9±8.8 years, 69.1% male), 122 patients were on ACE-I or ARB (ACE-I/ARB). ACE-I/ARB users were more likely to be on high-intensity statin therapy, which is known to stabilize plaques and reduce coronary inflammation (44.3% vs 23.8%, p=0.001). Treatment with ACE-I/ARB was not independently associated with lower PCAT attenuation (-73.5±7.3 HU vs. -71.6±8.0 HU; adjusted p=0.478), Subgroup analysis revealed lower PCAT attenuation in ACE-I/ARB users with glomerular filtration rate (GFR) <90 mL/min (-74.8±6.6 vs. -71.4±7.1 HU; p=0.038). Other antihypertensives (beta blockers, calcium channel blockers, thiazides) were not linked with lower likelihood of elevated coronary inflammation (PCAT attenuation ≥-70.5 HU). Conclusions: In T2DM patients with coronary atherosclerosis, ACE-I/ARB use was not independently associated with lower coronary inflammation as defined by PCAT attenuation, though benefits may exist in those with reduced GFR. Clinical Perspective: What is New?: In patients with type 2 diabetes mellitus and coronary atherosclerosis, treatment with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is not independently associated lower pericoronary adipose tissue attenuation, a marker of coronary inflammation on CT, but such benefit may exist in patients with glomerular filtration rate <90 mL/min.Other classes of antihypertensive medications (beta blockers, dihydropyridine calcium channel blockers, and thiazides) were also not associated with lower coronary inflammation.What are the Clinical Implications?: Unlike the high-intensity statins, no particular class of antihypertensive medications was shown to possess anti-inflammatory potential in coronary plaque stabilization but further studies are warranted to see whether patients with renal dysfunction would benefit more from angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in this clinical context.