The Impact of Glucose Control on Coronary Plaque Composition in Patients With Diabetes Mellitus

Dong Ju Yang, MD; Moo-Sik Lee, MD; Wan Ho Kim, MD; Hyun Woong Park, MD; Ki-Hong Kim, MD; Taek-Geun Kwon, MD; Sang-Wook Kim, MD; Charanjit S Rihal, MD; Amir Lerman, MD; Jang-Ho Bae, MD, PhD

Disclosures

J Invasive Cardiol. 2013;25(3):137-141. 

In This Article

Abstract and Introduction

Abstract

Background. Patients with diabetes mellitus (DM) are known to have large necrotic core in their coronary plaque compared to non-DM patients. We assessed coronary plaque composition in patients with angina and with/without DM according to glucose control.

Methods. Study subjects consisted of 114 non-DM patients, 14 well-controlled DM patients (hemoglobin A1c [HbA1c] <7.0%), and 37 poorly controlled DM patients (HbA1c ≥7%) who underwent virtual histology intravascular ultrasound (VH-IVUS) examinations of culprit lesions.

Results. The DM patients had longer lesion length (20.2 ± 7.8 mm vs 17.0 ± 7.3 mm; P=.013) than non-DM patients. The plaque volume was highest in the poorly-controlled DM patients (188.9 ± 92.6 mm3) compared with the non-DM patients (144.1 ± 92.3 mm3; P=.011) and the well-controlled DM patients (151.7 ± 82.4 mm3; P=.194). The well-controlled DM patients had less dense calcium (0.33 ± 0.14 mm3/mm vs 0.71 ± 0.60 mm3/mm; P=.020) and less necrotic core (0.71 ± 0.48 mm3/mm vs 1.30 ± 0.94 mm3/mm; P=.029) than the poorly-controlled DM patients and had similar amounts of dense calcium and necrotic core with non-DM patients, whereas fibrous and fibro-fatty volume showed no significant differences among the groups.

Conclusion. Coronary plaque composition and plaque volume in well-controlled DM patients are similar to those in non-DM patients and both groups had less dense calcium and necrotic core volume than the poorly-controlled DM patients. These findings suggest hyperglycemia control is important in DM patients with angina.

Introduction

Diabetes mellitus (DM) is one of the major risk factors for both acute and chronic coronary artery disease and is associated with worse prognosis.[1,2] The association of DM with cardiovascular diseases and worse prognoses is likely due to rupture of coronary plaque and the generation of thrombus which is easily induced from the metabolic disorder caused by DM.[3,4]

Coronary plaque in DM patients with stable angina is characterized by higher amounts of dense calcium and necrotic cores compared with non-DM patients.[5] However, there has been no report as to whether there are any differences of coronary plaque composition among different blood glucose control states in DM patients.

In this study, we investigated the histological characteristics of coronary plaques according to the blood glucose control state in DM patients with stable angina who received coronary artery intervention. Hemoglobin A1c (HbA1c) has been an established marker of glycemic control and its value is used to guide diabetic therapy.[6] We regarded HbA1c as the surrogate for blood glucose state. We hypothesized that histological characteristics may be different according to the status of blood glucose in diabetic patients with coronary artery disease.

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