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Impact of glycemic variability on coronary and peripheral endothelial dysfunction in patients with coronary artery

Kazuya Tateishi¹, Yuichi Saito¹, Hideki Kitahara¹

¹Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.

Journal of Cardiology

|August 30, 2021

Insights

High glucose variability is linked to coronary endothelial dysfunction in patients with coronary artery disease (CAD). This suggests glucose variability impacts the progression of coronary atherosclerosis.

Area of Science:

Cardiology
Endocrinology
Metabolic Syndrome

Background:

Glucose variability is implicated in endothelial dysfunction and atherosclerosis progression.
Direct evaluation of glucose variability's impact on coronary endothelial function in coronary artery disease (CAD) patients is limited.

Purpose of the Study:

To investigate the association between glucose variability and coronary endothelial function in patients with established CAD.

Main Methods:

Assessed coronary endothelial function via acetylcholine infusion and quantitative coronary angiography in 38 CAD patients with stenting.
Measured peripheral endothelial function using the reactive hyperemia index (RHI).
Quantified glucose variability using the mean amplitude of glycemic excursion (MAGE) from flash glucose monitoring.

Main Results:

Coronary endothelial function, assessed distally to stents, showed a significant negative correlation with MAGE (r = -0.38, p = 0.02).
Peripheral endothelial function (RHI) was not significantly associated with MAGE (r = -0.16, p = 0.35).
Diabetes mellitus was present in 45% of the study cohort.

Conclusions:

Increased glucose variability is significantly associated with impaired coronary endothelial function in CAD patients.
This association highlights a potential mechanism linking glucose variability to the progression of coronary atherosclerosis.

Read full analysis

Abstract

Background:

Previous studies have reported that glucose variability leads to endothelial dysfunction and progression of coronary atherosclerosis. However, few studies have directly evaluated the relation between glucose variability and coronary endothelial function in patients with coronary artery disease (CAD).

Methods:

A total of 38 patients with chronic CAD and a history of coronary drug-eluting stent implantation were enroled. Coronary endothelial function was evaluated by measuring the coronary vasoreactivity using quantitative coronary angiography in the segment distal to implanted stent in response to intracoronary acetylcholine (ACh) infusion (10-7 mol/l). Peripheral endothelial function was also assessed with reactive hyperemia index (RHI). The mean amplitude of glycemic excursion (MAGE) was calculated as a primary metric of glucose variability using a flash glucose monitoring system.

Results:

Of 38 patients, 17 (45%) had diabetes mellitus. The mean levels of glycated hemoglobin, MAGE, and RHI were 6.3 ± 0.8%, 71.4 ± 29.8 mg/dl, and 1.85 ± 0.63. In the distal segment to coronary stent, lumen diameter was constricted by 0.6 ± 7.3% in response to intracoronary ACh infusion compared to that at baseline. While peripheral endothelial function assessed with RHI was not significantly associated with MAGE (r = -0.16, p = 0.35), coronary endothelial function was correlated with MAGE (r = -0.38, p = 0.02).

Conclusion:

Greater glucose variability was significantly associated with coronary rather than peripheral endothelial dysfunction in patients with CAD, suggesting an impact of glucose variability on coronary atherosclerosis.

Keywords:

Acetylcholine Coronary artery disease Endothelial function Glucose variability

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