Relationship between Insulin Levels and Coronary Atherosclerosis in Newly Diagnosed Diabetes Mellitus and Impaired Glucose Toleranc

the prevalence of multivessel disease and long coronary lesions with small reference vessel diameters is high in patients with DM.Retrospective studies have demonstrated that patients with DM have more extensive coronary plaque compared with those without [3,4].It is believed that atherosclerosis occurs in the pre-diabetes stage [5].Therefore, abnormal glucose metabolism, such as that seen in patients with DM or impaired glucose tolerance (IGT), is recognized in over two-thirds of patients with cardiovascular disease such as acute myocardial infarction or angina pectoris [2,6,7].Hyperglycemia, particularly postprandial hyperglycemia, is a well-known pre-diabetic condition and a risk factor for all-cause mortality and cardiovascular disease [1,8,9].Some investigators have reported evidence that diabetic intervention therapy during the early phase of DM or IGT can have a preventive effect on cardiovascular events [10][11][12].However, assessment of coronary plaque in the prediabetes stage has not been sufficiently investigated.Coronary angiography (CAG) is the standard diagnostic test for coronary disease [13].However, measurement of vessel walls and plaque is impossible using CAG because it only provides a two-dimensional (2D) image of the vessel lumen.Moreover, early atherosclerosis can sometimes be overlooked; furthermore, the assessment of diffuse disease is difficult.Intravascular ultrasound (IVUS) can measure the vessel wall and quantify the amount of coronary plaque, and it is commonly used as a diagnostic tool and an adjuvant treatment tool [14].We examined the relationship between coronary atherosclerosis and abnormal glucose metabolism using IVUS in patients with acute coronary syndrome. Methods SubjectsIVUS-guided primary angioplasty of the Left Anterior Descending Artery (LAD) was performed for 205 patients with acute coronary syndrome between October 2003 and April 2007.A normal coronary was defined by a %diameter stenosis (%DS) of <20% according to Quantitative Coronary Angiography (QCA).