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Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a

Tomas Kovarnik1, Zhi Chen2, Gary S Mintz3

  • 12nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, II. interni klinika VFN a 1. LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic. tomas.kovarnik@vfn.cz.

Cardiovascular Diabetology
|December 8, 2017
PubMed

Insights

Patients with diabetes mellitus (DM) show faster coronary atherosclerosis progression and more advanced plaque phenotypes than non-diabetics, even with similar LDL cholesterol levels. Advanced plaque analysis reveals significant differences in disease progression between DM and non-DM patients.

Area of Science:

  • Cardiovascular Medicine
  • Diabetology
  • Medical Imaging

Background:

  • Coronary atherosclerosis progresses more rapidly in patients with diabetes mellitus (DM).
  • DM patients experience higher morbidity and mortality from coronary atherosclerosis compared to non-diabetic (non-DM) patients.
  • Lipid-lowering therapy is crucial for managing atherosclerosis, but its differential effects in DM versus non-DM patients require detailed investigation.

Purpose of the Study:

  • To quantify and compare changes in coronary plaque volume and phenotype during lipid-lowering therapy in DM versus non-DM patients.
  • To utilize advanced intracoronary imaging techniques for precise assessment of atherosclerosis progression.
  • To identify specific plaque characteristics that differ between DM and non-DM patients under treatment.

Main Methods:

  • Analysis of data from 61 stable angina patients in the PREDICT trial receiving intensive lipid-lowering therapy (40 mg rosuvastatin daily).
  • Fusion of two-plane angiography and intravascular ultrasound virtual histology (IVUS-VH) for 3-D vascular wall reconstruction and tissue characterization.
  • Calculation of frame-based plaque morphology indices and virtual histology analyses, including the Liverpool active plaque score (LAPS), in 698 vessel segments.

Main Results:

  • DM patients showed significantly higher progression in mean plaque area (0.47 vs. 0.21 mm², p=0.001) and percent atheroma volume (0.7% vs. -1.4%, p=0.007) compared to non-DM patients.
  • DM patients exhibited a greater increase in LAPS (0.23 vs. 0.13, p=0.018) and more Thin-Cap Fibro-Atheroma (TCFA) locations (20.3% vs. 12.5%, p=0.01).
  • Despite similar LDL cholesterol levels achieved, plaque changes were more pronounced in pathological intimal thickening (PIT) and TCFA phenotypes in DM patients.

Conclusions:

  • DM patients demonstrate advanced plaque phenotypes and accelerated atherosclerosis progression compared to non-DM patients, even when achieving similar LDL cholesterol levels.
  • Detailed 3D analysis reveals significant differences in plaque dynamics between DM and non-DM individuals under lipid-lowering therapy.
  • These findings underscore the need for tailored therapeutic strategies for atherosclerosis management in diabetic patients.
Abstract

Keywords:
AtherosclerosisDiabetes mellitusIntravascular ultrasoundStatins

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