NaF-PET/CT imaging of atherosclerosis in type 2 diabetes: Associations with sex and history of cardiovascular events in a 2-year follow-up study

PURPOSE: This study aims to evaluate the progression of atherosclerosis over two years in individuals with type 2 diabetes mellitus (T2DM) using sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) and to assess its relationship with sex and history of cardiovascular diseases (CVD).

METHODS: A total of 112 T2DM patients from the project "Specialist supervised individualized multifactorial treatment of new clinically diagnosed type 2 diabetes in general practice" (IDA) were included, divided into four groups based on sex and history of CVD events. All underwent NaF-PET/CT at baseline and after two years. Standardized uptake values (SUVs) were retrieved for the carotids, the heart, and the aorta. Partial correlations between NaF uptake and age, body mass index (BMI), low-density lipoprotein (LDL) cholesterol, blood pressure, and CT-derived coronary calcium score were evaluated, adjusted for history of CVD events and sex.

RESULTS: Females without CVD exhibited significantly higher NaF uptake than males without CVD, particularly in the aorta, SUVmean 1.62 ± 0.20 vs. 1.41 ± 0.20, p < 0.001. Positive correlations were found between NaF uptake in the aorta and age (r = 0.29, p = 0.002), BMI (r = 0.33, p < 0.001), and weight (r = 0.28, p = 0.002), but not LDL, blood pressure, or coronary artery calcium scores. Longitudinal analysis showed a significant average increase in NaF uptake of 0.07 (p = 0.04) in aorta over time in females without CVD, with no significant changes in other groups.

CONCLUSION: Our study suggests that microcalcification, indicated by NaF uptake, progresses differently between sexes. Menopausal females, particularly those without CVD, show higher uptake compared to others.