Key result
Diabetes in ACS patients linked to ~10% more lipid-rich plaque and earlier vulnerable features.
Why the study?
High cardiovascular mortality has been reported in young patients with diabetes, but the underlying coronary plaque pathology across different age groups has not been studied.
Do coronary plaque characteristics and underlying mechanisms of acute coronary syndrome differ across age groups in patients with diabetes compared to those without diabetes?
Cohort (n=1,394)
Do coronary plaque characteristics and underlying mechanisms of acute coronary syndrome differ across age groups in patients with diabetes compared to those without diabetes?
Answers are grounded in this paper and cite their sources.
Patients with diabetes presenting with acute coronary syndrome exhibit highly vulnerable atherosclerotic plaque features at a younger age compared to those without diabetes, suggesting earlier onset of vascular vulnerability.
Background High cardiovascular mortality has been reported in young patients with diabetes. However, the underlying pathology in different age groups of patients with diabetes has not been studied. Methods and Results The aim of this study was to investigate the plaque characteristics and underlying pathology of acute coronary syndrome in different age groups of patients with or without diabetes in a large cohort. Patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography imaging were included. Culprit plaque was classified as plaque rupture, plaque erosion, or calcified plaque and stratified into 5 age groups. Plaque characteristics including features of vulnerability were examined by optical coherence tomography. Among 1394 patients, 482 (34.6%) had diabetes. Patients with diabetes, compared with patients without diabetes, had a higher prevalence of lipid‐rich plaque (71.2% versus 64.8%, P =0.016), macrophage (72.0% versus 62.6%, P <0.001), and cholesterol crystal (27.6% versus 19.7%, P <0.001). Both diabetes and nondiabetes groups showed a decreasing trend in plaque erosion with age (patients with diabetes, P =0.020; patients without diabetes, P <0.001). Patients without diabetes showed an increasing trend with age in plaque rupture ( P =0.004) and lipid‐rich plaque ( P =0.018), whereas patients with diabetes had a high prevalence of these vulnerable features at an early age that remained high across age groups. Conclusions Patients without diabetes showed an increasing trend with age in plaque rupture and lipid‐rich plaque, whereas patients with diabetes had a high prevalence of these vulnerable features at an early age. These results suggest that atherosclerotic vascular changes with increased vulnerability start at a younger age in patients with diabetes. Registration URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT04523194, NCT03479723. URL: https://www.umin.ac.jp/ctr/ . Unique identifier: UMIN000041692.
No takes yet. Share an insight, caveat, or question.
Suzuki et al. (2023) conducted a cohort in Acute coronary syndrome (n=1,394). Diabetes vs. Without diabetes was evaluated on Prevalence of lipid-rich plaque (p=0.016). Patients with diabetes and acute coronary syndrome had more lipid-rich plaque (71.2% vs 64.8%, P=0.016) and exhibited vulnerable plaque features at an earlier age than patients without diabetes.
Synapse has enriched 10 related papers. Consider them for comparative context: