Effect of daily glucose fluctuation on coronary plaque vulnerability in patients pre-treated with lipid-lowering therapy: a prospective observational study

JACC Cardiovasc Interv. 2015 May;8(6):800-811. doi: 10.1016/j.jcin.2014.11.025.

Abstract

Objectives: This study sought to investigate the effect of daily glucose fluctuation on coronary plaque properties in patients with coronary artery disease (CAD) pre-treated with lipid-lowering therapy.

Background: There is growing evidence that glucose fluctuation, as a residual risk apart from dyslipidemia, is an important factor contributing to the development of CAD.

Methods: This prospective study enrolled 70 consecutive CAD patients who were referred for percutaneous coronary intervention and whose low-density lipoprotein cholesterol level was <120 mg/dl under statin treatment or <100 mg/dl without statins. Daily glucose fluctuation was analyzed by measuring the mean amplitude of glycemic excursion (MAGE). The plaque properties in the culprit and nonculprit lesions were assessed by virtual histology intravascular ultrasound, and the volume percentage of necrotic core within the plaque (%NC) and the presence of thin-cap fibroatheroma were evaluated.

Results: In total, 165 lesions were evaluated in 70 patients (40 diabetic and 30 nondiabetic patients). %NC was well correlated with MAGE (r = 0.490, p <0.001). A linear mixed effect model showed that MAGE had the strongest effect on %NC (coefficient β = 0.080 ± 0.020 [standard error], p < 0.001). The generalized linear mixed effect model revealed that MAGE was the only independent predictor of the presence of thin-cap fibroatheroma (odds ratio: 1.037; 95% confidence interval: 1.010 to 1.065; p = 0.007).

Conclusions: Daily glucose fluctuation may have an effect on coronary plaque vulnerability in patients with CAD pre-treated with lipid-lowering therapy. Further investigations should address the rationale for the early detection and control of glucose fluctuation in the era of universal statin use for CAD patients.

Keywords: continuous glucose monitoring; glucose fluctuation; mean amplitude of glycemic excursion; thin-cap fibroatheroma; virtual histology intravascular ultrasound.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Blood Glucose / metabolism*
  • Cholesterol, LDL / blood
  • Coronary Angiography
  • Coronary Artery Disease / blood
  • Coronary Artery Disease / diagnosis
  • Coronary Artery Disease / etiology*
  • Coronary Artery Disease / therapy
  • Coronary Vessels / diagnostic imaging
  • Coronary Vessels / pathology*
  • Dyslipidemias / blood
  • Dyslipidemias / complications
  • Dyslipidemias / diagnosis
  • Dyslipidemias / drug therapy*
  • Early Diagnosis
  • Female
  • Fibrosis
  • Glucose Metabolism Disorders / blood
  • Glucose Metabolism Disorders / complications*
  • Glucose Metabolism Disorders / diagnosis
  • Glucose Tolerance Test
  • Humans
  • Hypolipidemic Agents / therapeutic use*
  • Japan
  • Male
  • Monitoring, Ambulatory / methods
  • Necrosis
  • Odds Ratio
  • Percutaneous Coronary Intervention
  • Plaque, Atherosclerotic*
  • Predictive Value of Tests
  • Prospective Studies
  • Registries
  • Risk Factors
  • Rupture, Spontaneous
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Interventional

Substances

  • Biomarkers
  • Blood Glucose
  • Cholesterol, LDL
  • Hypolipidemic Agents