The relationship between glycemic risk and longitudinal changes in total physiological atherosclerotic burden in
Jiapeng Chu1, Yan Lai1, Yian Yao1
1Department of Cardiology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Insights
Poor glycemic control, indicated by higher HbA1c levels, is linked to worsening coronary artery disease progression. This association is particularly significant in patients with diabetes mellitus (DM).
Area of Science:
- Cardiology
- Endocrinology
- Medical Imaging
Background:
- Glycemic status and its impact on coronary physiology remain under-investigated.
- Understanding these effects is crucial for managing patients with coronary artery disease (CAD) and diabetes mellitus (DM).
Purpose of the Study:
- To evaluate changes in coronary physiology using quantitative flow ratio (QFR).
- To examine the relationship between diabetes mellitus (DM), glycemic control, and coronary physiological changes.
Main Methods:
- Retrospective cohort study of 530 patients undergoing serial coronary angiography (CAG).
- Quantitative flow ratio (QFR) measurements, specifically 3-vessel QFR (3V-QFR), were performed.
- Functional progression of CAD was defined as a significant decrease in 3V-QFR over time.
Main Results:
- Functional progression of CAD was observed in 31.9% of patients.
- Higher follow-up glycosylated hemoglobin (HbA1c) levels predicted coronary functional progression (AUC=0.599).
- Diabetic patients with HbA1c ≥7.0% showed significantly lower Δ3V-QFR compared to well-controlled diabetic or non-diabetic patients.
- Elevated HbA1c was independently associated with 3V-QFR progression (OR=1.263), especially in diabetic patients (OR=1.353).
Conclusions:
- On-treatment HbA1c levels are independently associated with the progression of physiological atherosclerotic burden in patients with established CAD.
- This association is particularly pronounced in patients with diabetes mellitus (DM).
Background:
The effects of glycemic status on coronary physiology have not been well evaluated. This study aimed to investigate changes in coronary physiology by using angiographic quantitative flow ratio (QFR), and their relationships with diabetes mellitus (DM) and glycemic control status.
Methods:
This retrospective cohort study included 530 patients who underwent serial coronary angiography (CAG) measurements between January 2016 and December 2021 at Tongji Hospital of Tongji University. Based on baseline and follow-up angiograms, 3-vessel QFR (3V-QFR) measurements were performed. Functional progression of coronary artery disease (CAD) was defined as a change in 3V-QFR (Δ3V-QFR = 3V-QFRfollow-up - 3V-QFRbaseline) ≤-0.05. Univariable and multivariable logistic regression analyses were applied to identify the independent predictors of coronary functional progression. Subgroup analysis according to diabetic status was performed.
Results:
During a median interval of 12.1 (10.6, 14.3) months between the two QFR measurements, functional progression was observed in 169 (31.9%) patients. Follow-up glycosylated hemoglobin (HbA1c) was predictive of coronary functional progression with an area under the curve (AUC) of 0.599 [95% confidence interval (CI): 0.546-0.651; P<0.001] in the entire population. Additionally, the Δ3V-QFR values were significantly lower in diabetic patients with HbA1c ≥7.0% compared to those with well-controlled HbA1c or non-diabetic patients [-0.03 (-0.09, 0) vs. -0.02 (-0.05, 0.01) vs. -0.02 (-0.05, 0.02); P=0.002]. In a fully adjusted multivariable logistics analysis, higher follow-up HbA1c levels were independently associated with progression in 3V-QFR [odds ratio (OR), 1.263; 95% CI: 1.078-1.479; P=0.004]. Furthermore, this association was particularly strong in diabetic patients (OR, 1.353; 95% CI: 1.082-1.693; P=0.008) compared to patients without DM.
Conclusions:
Among patients with established CAD, on-treatment HbA1c levels were independently associated with progression in physiological atherosclerotic burden, especially in patients with DM.
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