SGLT2 Inhibitors on Coronary Atherosclerosis Progression Via Perivascular Adipose Tissue in Diabetes

Progression of total plaque volume (TPV) （mm³）from baseline or appearance of new plaques, assessed by coronary CT angiography (CCTA). Includes changes in plaque components (e.g., necrotic core, fibrous cap, calcification)（mm³）.

Change from baseline to the 18-month follow-up in the coronary perivascular fat radiomics score (FRS), measured in "points", where a higher score indicates a higher inflammatory activity state and a stronger correlation with the risk of major adverse cardiovascular events.

Change from baseline to the 18-month follow-up in CT-derived fractional flow reserve (CT-FFR), expressed as a pure number between 0 and 1 (no units), where a higher value indicates a lower likelihood of ischemia.

Change from baseline to the 18-month follow-up in fat attenuation index (FAI)(HU) .FAI is defined as the mean attenuation value of pericoronary adipose tissue observed on CT scan, ranging from approximately -190 to -30 HU. Higher values indicating increased perivascular adipose tissue inflammation and coronary vulnerability, and lower values suggesting a more stable, anti-inflammatory vascular state.

Change from baseline to the 18-month follow-up in the degree of coronary artery stenosis, expressed as CAD-RADS category or quantitatively measured percent stenosis. CAD-RADS grades range from 0 to 5, with higher grades indicating greater stenosis severity. Quantitatively measured percent stenosis ranges from 0% to 100%, with higher percentages indicating greater stenosis severity.

Change from baseline to the 18-month follow-up in C-reactive protein (CRP). Reference range: 0-0.8 mg/L; Unit: mg/dL.

Change from baseline to the 18-month follow-up in quality of life score measured by the Seattle Angina Questionnaire (SAQ-7). The total score ranges from 0 to 100, with higher scores indicating better quality of life and better angina control.

Occurrence of major adverse cardiovascular events (MACE), including but not limited to cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke, from baseline to the 18-month follow-up.

Change from baseline to the 18-month follow-up in the Self-Rating Anxiety Scale (SAS) score. The SAS is a 20-item self-reported scale with 4-point scoring, designed to assess the subjective experience of anxiety in patients. Total scores range from 0 to 60, with higher scores indicating greater anxiety severity. The scores are interpreted as follows:

A (0-8): no anxiety disorder B (9-21): occasional anxiety C (22-32): mild anxiety disorder D (33-44): moderate anxiety disorder E (45-60): severe anxiety disorder

Change from baseline to the 18-month follow-up in the Hamilton Anxiety Scale (HAMA) score. HAMA is a clinician-rated scale consisting of 14 items, each scored from 0 to 4, where:

0 = asymptomatic

• = mild symptoms
• = moderate symptoms (clearly present but does not affect daily life)
• = severe symptoms (significantly affects daily life)
• = extremely severe symptoms (unable to function normally)

Total scores range from 0 to 56, with higher scores indicating more severe anxiety. The score is interpreted as follows:

<7: no anxiety symptoms 7-13: possible anxiety 14-20: mild anxiety 21-28: marked anxiety 29: severe anxiety

Change from baseline to the 18-month follow-up in wall shear stress (WSS)(Pa).Both excessively high and abnormally low WSS are pathological: high WSS promotes plaque destabilization and rupture, while low WSS accelerates atherogenesis and plaque growth.

Change from baseline to the 18-month follow-up in Pericoronary Adipose Tissue Volume (mm³).Larger volume indicates higher inflammatory activity or greater disease burden, whereas smaller volume indicates the opposite.

Change from baseline to the 18-month follow-up in lipoprotein(a) (Lp(a)). Reference range: <30 mg/dL; Unit: mg/dL.

Change from baseline to the 18-month follow-up in low-density lipoprotein cholesterol (LDL-C). Reference range: 0-3.4; Unit: mmol/L.

Change from baseline to the 18-month follow-up in high-density lipoprotein cholesterol (HDL-C). Reference range: 1-1.6 ; Unit: mmol/L.

Change from baseline to the 18-month follow-up in triglycerides (TG). Reference range: 0.4-1.7; Unit: mmol/L.

Change from baseline to the 18-month follow-up in total cholesterol (TC). Reference range: 3.1-5.7; Unit: mmol/L.

Change from baseline to the 18-month follow-up in interleukin-6 (IL-6). Reference range: 0-5.9 pg/mL; Unit: pg/mL.

Change from baseline to the 18-month follow-up in tumor necrosis factor-alpha (TNF-α). Reference range: <20; Unit: ng/L.