| Sumario: | 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. 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. 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%). 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. • 18F-NaF PET provides unique insights into drivers of coronary microcalcification activity in people with diabetes • PCAT can be reliably measured on non-contrast studies, and associates with measures of cardiometabolic disease • Higher NC-PCAT values associate with increased CMA burden in people with diabetes mellitus • NC-PCAT may imrprove CVD risk stratification above the CCS in people with diabetes, although further research is needed.
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