Abstract
BackgroundThe incidence of cardiac events is higher in patients with diabetes than in people without diabetes. The Coronary Atherosclerosis Study Measuring Effects of Rosuvastatin Using Intravascular Ultrasound in Japanese Subjects (COSMOS) demonstrated significant plaque regression in Japanese patients with chronic coronary disease after 76 weeks of rosuvastatin (2.5 mg once daily, up-titrated to a maximum of 20 mg/day to achieve LDL cholesterol <80 mg/dl).MethodsIn this subanalysis of COSMOS, we examined the association between HbA1c and plaque regression in 40 patients with HbA1c ≥6.5% (high group) and 86 patients with HbA1c <6.5% (low group).ResultsIn multivariate analyses, HbA1c and plaque volume at baseline were major determinants of plaque regression. LDL cholesterol decreased by 37% and 39% in the high and low groups, respectively, while HDL cholesterol increased by 16% and 22%, respectively. The reduction in plaque volume was significantly (p = 0.04) greater in the low group (from 71.0 ± 39.9 to 64.7 ± 34.7 mm3) than in the high group (from 74.3 ± 34.2 to 71.4 ± 32.3 mm3). Vessel volume increased in the high group but not in the low group (change from baseline: +4.2% vs −0.8%, p = 0.02). Change in plaque volume was significantly correlated with baseline HbA1c.ConclusionsDespite similar improvements in lipid levels, plaque regression was less pronounced in patients with high HbA1c levels compared with those with low levels. Tight glucose control during statin therapy may enhance plaque regression in patients with stable coronary disease.Trial registrationClinicalTrials.gov, Identifier NCT00329160
Highlights
The incidence of cardiac events is higher in patients with diabetes than in people without diabetes
The mean rosuvastatin dose at follow-up Intravascular ultrasound (IVUS) was 16.9 ± 5.3 mg/day, and 92/126 patients (72.2%) were on the maximum rosuvastatin dose (20 mg/day). In these patients, the percent changes in LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) were −38.6 ± 16.9% and +19.8 ± 22.9%
The same correlation was not apparent in non-diabetic patients (r = 0.062, p = 0.58, Figure 1c). In this subanalysis of the COSMOS study, we found that baseline HbA1c was significantly associated with change in plaque volume
Summary
The incidence of cardiac events is higher in patients with diabetes than in people without diabetes. Plaque regression has been documented in several studies using IVUS to investigate the effects of lipidlowering therapies, as well as those of anti-hypertensive drugs and anti-diabetic drugs [7,8,9,10]. The results of those studies indicate that plaque regression is influenced by several clinical factors, including lipid profiles, diabetic status and blood pressure. Several epidemiological studies have shown a positive association between HbA1c and risk of cardiovascular disease [14,15] It is unknown whether glucose control is associated with the change in plaque volume following interventions to treat dyslipidaemia, for example
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