Statin-induced improvements in vulnerable plaques are attenuated in poorly controlled diabetic patients with coronary atherosclerosis disease: a serial optical coherence tomography analysis.

Abstract

The incidence of cardiac events is increased in diabetic patients even after lipid-lowering therapy. This study aimed to compare the statin-induced changes in the characteristics of vulnerable plaques in patients without diabetes mellitus (DM) and in those with better- or poorly controlled DM, measured by optical coherence tomography (OCT). This was a retrospective study of 99 non-culprit lipid-rich plaques from 75 patients who underwent intensive OCT imaging examination. Thirty-four non-diabetic patients were assigned to Group A. According to the average HbA1c level, 22 diabetic patients were assigned to Group B, and 19, to Group C (average HbA1c<8 and ≥8%, respectively). Following 12months of statin therapy, similar improvements in serum lipid levels were observed in the three groups. However, the increase in fibrous-cap thickness of plaques was the highest in Group A (Group A, 183%; Group B, 104%; and Group C, 53%). Significant reductions in lipid volume index were observed in Groups A and B (Group A: -12%, P<0.001; Group B: -13%, P=0.038; Group C: 7%, P=0.948). Percent changes in OCT measurements were significantly correlated with average HbA1c in patients. Improved glucose control may enhance the statin-induced reduction in characteristics of vulnerable plaque in diabetic patients.