Key result
Obesity in early-stage diabetes is linked to ~3-fold greater coronary atheroma progression versus non-obese patients.
Why the study?
Does obesity accelerate coronary atheroma progression, and does glycemic control attenuate this progression in early-stage diabetic patients with CAD?
Cohort (n=252)
Open-label with blinded endpoint assessment
Yes
Does obesity accelerate coronary atheroma progression, and does glycemic control attenuate this progression in early-stage diabetic patients with CAD?
Mean Difference: 9.874 (95% CI 0.123–19.626)
Absolute Event Rate: 24.7% vs 7.4%
p-value: p=0.04
Obese patients with early-stage diabetes and CAD exhibit accelerated coronary atheroma progression, which can be significantly attenuated by achieving optimal glycemic control.
May warrant closer CAD surveillance in obese early-diabetes patients; leaves open glycemic control's attenuating role.
AIM: Diabetes is accompanied by abdominal obesity, which produces various metabolic abnormalities. While metabolic factors have been considered to promote the development of coronary atherosclerosis in the early-stage of diabetes, it remains unknown whether the presence of obesity in early-stage diabetics affects the natural history of coronary atherosclerosis. We herein investigated the characteristics of the disease substrate in obese early-stage diabetics. METHODS: The DIANA (DIAbetes and diffuse coronary NArrowing) study was a serial evaluation of angiographic disease progression in early-stage diabetics with coronary artery disease. A total of 252 study subjects were stratified into non-obese (n=168) and obese groups (n=84). Obesity in Japanese subjects was defined as a body mass index ≥25 kg/m(2) according to the statement about Japanese obesity from the Japan Society for the Study of Obesity. Coronary atherosclerotic changes were evaluated by a quantitative computed analysis. The total lesion length (TLL=total length of all atherosclerotic lesions) was compared between the groups. RESULTS: The obese patients were younger (p=0.0002) and had higher levels of fasting (p=0.002) and postprandial insulin (p=0.01), and higher triglyceride levels (p=0.02). On serial angiographic evaluations, obese patients had greater disease progression, reflected by a larger percent change in the TLL (24.7±13.7 vs. 7.4±10.0%, p=0.04). However, the improvement of abnormal glucose tolerance was associated with a slowing of disease progression in both non-obese (-0.9±10.7 vs. ＋15.0±11.2%, p=0.04) and obese (＋4.2±22.8 vs. ＋55.5±26.5%, p=0.005) patients. CONCLUSIONS: Obese patients with early-stage diabetes exhibit profound disease progression. Glycemic control attenuated the progression of their coronary atherosclerosis. Our findings indicate progressive but modifiable disease in obese early-stage diabetics under optimal glycemic management.
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Kataoka et al. (2014) conducted a cohort in Early-stage diabetes with coronary artery disease (n=252). Obesity (BMI ≥ 25 kg/m2) vs. Non-obese (BMI < 25 kg/m2) was evaluated on Percent change in total lesion length (TLL) (MD 9.874, 95% CI 0.123-19.626, p=0.04). Obese patients with early-stage diabetes exhibited significantly greater coronary atheroma progression compared to non-obese patients, with a 24.7% versus 7.4% increase in total lesion length over one year.
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