Abstract
BackgroundGlucose fluctuation has been recognized as a residual risk apart from dyslipidemia for the development of coronary artery disease (CAD). This study aimed to investigate the association between glucose fluctuation and coronary plaque morphology in CAD patients.MethodsThis prospective study enrolled 72 consecutive CAD patients receiving adequate lipid-lowering therapy. They were divided into 3 tertiles according to the mean amplitude of glycemic excursions (MAGE), which represents glucose fluctuation, measured by continuous glucose monitoring (tertile 1; <49.1, tertile 2; 49.1 ~ 85.3, tertile 3; >85.3). Morphological feature of plaques were evaluated by optical coherence tomography. Lipid index (LI) (mean lipid arc × length), fibrous cap thickness (FCT), and the prevalence of thin-cap fibroatheroma (TCFA) were assessed in both culprit and non-culprit lesions.ResultsIn total, 166 lesions were evaluated. LI was stepwisely increased according to the tertile of MAGE (1958 ± 974 [tertile 1] vs. 2653 ± 1400 [tertile 2] vs. 4362 ± 1858 [tertile 3], p <0.001), whereas FCT was the thinnest in the tertile 3 (157.3 ± 73.0 μm vs. 104.0 ± 64.1 μm vs. 83.1 ± 34.7 μm, p <0.001, respectively). The tertile 3 had the highest prevalence of TCFA. Multiple linear regression analysis showed that MAGE had the strongest effect on LI and FCT (standardized coefficient β = 0.527 and −0.392, respectively, both P <0.001). Multiple logistic analysis identified MAGE as the only independent predictor of the presence of TCFA (odds ratio 1.034; P <0.001).ConclusionsGlucose fluctuation and hypoglycemia may impact the formation of lipid-rich plaques and thinning of fibrous cap in CAD patients with lipid-lowering therapy.
Highlights
Dyslipidemia, especially a high low-density lipoprotein (LDL) cholesterol level, has been recognized as the most important promoter of atherosclerotic cardiovascular disease
Patient population Seventy-two consecutive patients who had been referred for percutaneous coronary intervention (PCI) for coronary artery disease (CAD) during the period from June 2012 to April 2015 and who fulfilled the following inclusion criteria were enrolled in this prospective registry (Fig. 1): 20–80 years of age under adequate treatment of dyslipidemia; LDL cholesterol levels
The novel findings of this study can be summarized as follows: 1) in CAD patients under adequate treatment for dyslipidemia, glucose fluctuation might be an important contributing factor to the formation of lipidrich plaque; 2) a longer time in hypoglycemia was significantly correlated with a thinner fibrous cap thickness (FCT); and 3) coronary plaque calcification was associated with the duration of Diabetes mellitus (DM) rather than daily glucose fluctuation
Summary
Dyslipidemia, especially a high low-density lipoprotein (LDL) cholesterol level, has been recognized as the most important promoter of atherosclerotic cardiovascular disease. A large number of clinical trials have reported beneficial effects of statins for primary and secondary prevention and improved all-cause mortality in association with lowering LDL cholesterol levels [1, 2]. Diabetes mellitus (DM) is a major risk factor for coronary artery disease (CAD) [3]. Recent investigations have revealed that compared with continuous hyperglycemia, large glucose fluctuation, such as postprandial hyperglycemia, might be one of the most deleterious factors in cardiovascular disease [5, 6]. Whether glucose fluctuation, including hypoglycemia, may have an impact on coronary plaque properties remains unclear. Glucose fluctuation has been recognized as a residual risk apart from dyslipidemia for the development of coronary artery disease (CAD). This study aimed to investigate the association between glucose fluctuation and coronary plaque morphology in CAD patients
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