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Editor’s note: The cardiovascular burden of diabetes is well established. The authors of this large cohort study of a prospective, international, multicenter registry examined 23643 individuals who underwent coronary computed tomography angiography, and compared 3370 individuals with diabetes with 6740 individuals without the condition. The subjects were matched for coronary risk factors. People with diabetes were more likely to have obstructive coronary artery disease (CAD), defined as ≥50% stenosis.