Effect of Diabetes on Progression of Coronary Atherosclerosis and Arterial Remodeling

Nicholls, Stephen J.; Tuzcu, E. Murat; Kalidindi, Srinivasa R; Wolski, Kathy; Moon, Keon Woong; Sipahi, İlke; Schoenhagen, Paul; Nissen, Steven E.

doi:10.1016/j.jacc.2008.03.051

Cited by 313 publications

(209 citation statements)

References 42 publications

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“…Furthermore, intravascular ultrasound findings also showed that the presence of diabetes was associated with a greater atherosclerotic burden and impaired compensatory remodeling of the artery wall. 36 In this study, a higher baPWV was significantly associated with an increasing number of diseased vessels in both CAD patients and CAD patients with diabetes, suggesting that baPWV may reflect the severity of CAD in the diabetic population. Although the duration and extent of diabetes appear to influence atherosclerosis levels and the prognosis in diabetic CAD patients, this study revealed that the baPWV, an index of arterial stiffness, can predict the prognosis in this population.…”

Section: Coronary Atherosclerosis and Diabetessupporting

confidence: 51%

“…Intensive statin treatment may regress coronary atherosclerosis, but might not be effective in patients with diabetes. 36,39,40 There is an ongoing need to develop additional therapies with the aim of reducing the atherosclerotic burden and inhibiting cardiovascular events in CAD patients with both diabetes and advanced arterial stiffness.…”

Section: Cad and Diabetesmentioning

confidence: 99%

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Brachial-ankle pulse wave velocity as a risk stratification index for the short-term prognosis of type 2 diabetic patients with coronary artery disease

et al. 2010

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, the Shinken Database Study GroupThe incidence of diabetes is increasing, and the disease has become an important predictor of prognosis in patients with coronary artery disease (CAD), although adverse events often occur without warning. Thus, risk stratification of diabetic CAD patients is important for secondary prevention. This study tests the hypothesis that brachial-ankle pulse wave velocity (baPWV), a marker for arterial stiffness obtained by simple and noninvasive automated devices, can be a risk stratification index to predict prognosis in diabetic patients with CAD. The prognosis of CAD patients with diabetes in the Shinken Database cohort study was investigated by dividing patients into two groups based on baPWV measurements. The composite endpoint was death, nonfatal myocardial infarction, repeat revascularization or readmission for heart failure. Data were available on 564 CAD patients, with a median follow-up of 25.4 months. Of these patients, 191 had type 2 diabetes. The higher baPWV among diabetic patients was defined as a median baPWV of 1730 cm s -1 or more. The 3-year Kaplan-Meier estimates of event-free survival were 72.8% in diabetic patients with lower baPWV and 51.3% in those with higher baPWV, respectively (P¼0.031). Multivariate analysis revealed that a higher baPWV was independently associated with poorer short-term prognosis (hazard ratio, 1.97; 95% confidence interval, 1.01-3.84) in diabetic CAD patients. In conclusion, baPWV, a marker for arterial stiffness, can be a risk stratification index for short-term prognosis in clinical practice, suggesting the need for further aggressive treatment and strict follow-up in CAD patients with diabetes and higher baPWV.

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Section: Coronary Atherosclerosis and Diabetessupporting

confidence: 51%

Section: Cad and Diabetesmentioning

confidence: 99%

Brachial-ankle pulse wave velocity as a risk stratification index for the short-term prognosis of type 2 diabetic patients with coronary artery disease

et al. 2010

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“…Moreover, poorly controlled DM is associated with a greater lipid burden 18. Intravascular ultrasound studies have shown that patients with DM and ACS have greater plaque burden and necrotic core volume at the culprit lesions compared with patients with ACS but not DM 20, 21. In contrast, previous OCT studies did not demonstrate the differences in the prevalence of lipid‐rich plaque or TCFA at the culprit lesion 6, 8, 22, 23.…”

Section: Discussionmentioning

confidence: 95%

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

Sugiyama

Yamamoto

Bryniarski

et al. 2018

JAHA

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BackgroundDiabetes mellitus (DM) is a major risk factor for cardiovascular events. We aimed to investigate the coronary plaque phenotype of diabetic patients who presented with acute coronary syndromes by optical coherence tomography.Methods and ResultsA total of 322 patients with acute coronary syndromes who underwent preintervention optical coherence tomography imaging of the culprit lesion were included. Culprit plaque characteristics were compared between patients with DM (n=95) and those without DM (n=227). In the subgroup of 250 patients in whom sufficient length of nonculprit region in the culprit vessel was imaged by optical coherence tomography, the characteristics of nonculprit plaques were also evaluated. Patients with DM had a higher prevalence of lipid‐rich plaque (58.9% versus 44.9%, P=0.030) and macrophage accumulation (60.0% versus 44.9%, P=0.019) in the culprit lesion compared with patients without DM. The prevalence of plaque rupture (33.7% versus 30.4%, P=0.896) and plaque erosion (21.1% versus 22.0%, P=0.458) was similar. In the nonculprit lesions, the DM group had greater maximal lipid arc (248.9°±83.9° versus 179.9°±58.3°, P=0.006), thinner fibrous cap thickness (103.3±56.2 μm versus 140.7±70.0 μm, P=0.013), and a higher prevalence of thin‐cap fibroatheroma (17.2% versus 6.3%, P=0.031), compared with the non‐DM group.ConclusionsCompared with patients without DM, those with DM had more vulnerable features in both culprit and nonculprit lesions, thus indicating a higher level of panvascular instability.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01110538.

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“…154 Intensive lowering of LDL-C had a beneficial effect on progression of atheroma in DM and non-DM subjects. 155 Intensification of LDL-C lowering can be achieved by adding ezetimibe to a statin. Although there are no RCT data on CVD outcome, a trial is under way (IMPROVE-IT [IMProved Reduction of Outcomes: Vytorin Efficacy International Trial]: ClinicalTrials.gov: NCT00202878).…”

Section: Management Of Dyslipidaemiamentioning

confidence: 99%

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

diabetes

Rydén

Grant

et al. 2014

Diabetes and Vascular Disease Research

176

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Effect of Diabetes on Progression of Coronary Atherosclerosis and Arterial Remodeling

Abstract: Diabetes is accompanied by more extensive atherosclerosis and inadequate compensatory remodeling. Accelerated plaque progression, despite use of medical therapies, supports the need to develop new antiatherosclerotic strategies in diabetic patients.

Cited by 313 publications

References 42 publications

Brachial-ankle pulse wave velocity as a risk stratification index for the short-term prognosis of type 2 diabetic patients with coronary artery disease

Brachial-ankle pulse wave velocity as a risk stratification index for the short-term prognosis of type 2 diabetic patients with coronary artery disease

Coronary Plaque Characteristics in Patients With Diabetes Mellitus Who Presented With Acute Coronary Syndromes

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

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