Plaque Characteristics in Coronary Artery Disease Patients with Impaired Glucose Tolerance

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Coronary artery disease (n=101). Intervention: Impaired glucose tolerance vs. Normal glucose tolerance. Primary outcome: Mean angle of the lipid arc (p=0.039).

Keishi Suzuki; Hitoshi Takano; Yoshiaki Kubota; Keisuke Inui; Shunichi Nakamura; Yukichi Tokita; Koji Kato; Kuniya Asai; Wataru Shimizu

doi:10.1371/journal.pone.0167645

December 9, 2016PLoS ONEOpen Access

Plaque Characteristics in Coronary Artery Disease Patients with Impaired Glucose Tolerance

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Key result

In patients with coronary artery disease, impaired glucose tolerance was associated with a significantly larger mean lipid arc (163.0° vs 130.9°) and thinner fibrous cap (77.0 μm vs 105.6 μm) compared to normal glucose tolerance.

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Why the study?

Does impaired glucose tolerance or diabetes mellitus increase coronary plaque vulnerability compared to normal glucose tolerance in patients with coronary artery disease?

Key Points

To compare coronary plaque vulnerability and morphological characteristics among coronary artery disease patients with normal glucose tolerance, impaired glucose tolerance, and diabetes mellitus using optical coherence tomography.
Enrolled 101 coronary artery disease patients (mean age, 67.9 ± 10.4 years; 82.4% male) categorized into normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and diabetes mellitus (DM) groups.
Performed optical coherence tomography on target and non-target vessels during percutaneous coronary intervention to evaluate 136 non-target residual plaques.
Mean lipid core arc was significantly larger in the IGT (163.0 ± 58.7°) and DM (170.1 ± 59.3°) groups than in the NGT group (130.9 ± 37.7°, P < 0.05).
Fibrous cap thickness covering the lipid core was significantly thinner in the IGT group compared with the NGT group (77.0 ± 23.4 μm vs. 105.6 ± 47.0 μm, P = 0.040).

Study Design

Type

Cross-Sectional (n=101)

Multicenter

No

Structured PICO

Does impaired glucose tolerance or diabetes mellitus increase coronary plaque vulnerability compared to normal glucose tolerance in patients with coronary artery disease?

P

Population

101 patients (mean age 67.9 years, 17.6% female) with coronary artery disease undergoing percutaneous coronary intervention who had optical coherence tomography of non-target vessels.

E

Exposure

Impaired glucose tolerance (IGT) and Diabetes Mellitus (DM) (Exposure groups)

C

Comparator

Normal glucose tolerance (NGT)

O

Outcome

Coronary plaque characteristics, specifically the size of the lipid core (expressed as the mean angle of the lipid arc) and fibrous cap thickness, assessed by optical coherence tomography (OCT)surrogate

Main Result

Absolute Event Rate: 163% vs 130.9%

p-value: p=0.039

Coronary plaques in CAD patients with impaired glucose tolerance exhibit increased vulnerability, characterized by larger lipid cores and thinner fibrous caps, similar to those seen in patients with diabetes mellitus.

Limitations

Subanalysis from an institutional registry at a single hospital with a small sample size.
OCT was performed by the operator's intention, introducing potential selection bias.
Exact measurements of the necrotic core and plaque burden were not possible due to shallow axial penetration.
Cross-sectional observational design cannot determine the influence of glucose tolerance on sequential changes in plaque morphology.
Subanalysis from an institutional registry at a single hospital
Small sample size
Selection bias (OCT was performed by the operator's intention)
Exact measurements of the necrotic core and plaque burden on OCT were not possible because of a relatively shallow axial penetration
Cross-sectional observational study design which failed to examine the influence of glucose tolerance abnormality on sequential changes of plaque morphology

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Implication

IGT-linked plaques show vulnerability features akin to DM; hypothesis-generating for targeted risk modification in prediabetes.

Abstract

BACKGROUND: Impaired glucose tolerance (IGT) patients are known to have a high risk of cardiovascular events and their prognosis has been reported to be poor. The present study aimed to compare coronary plaque characteristics among coronary artery disease (CAD) patients with normal glucose tolerance (NGT), those with IGT, and those with diabetes mellitus (DM) by using optical coherence tomography (OCT). METHODS: The present study included 101 coronary artery disease patients (mean age, 67.9 ± 10.4 years; 82.4% male). OCT was performed for target and non-target vessels during percutaneous coronary intervention. The patients were divided into the following 3 groups: the NGT, IGT, and DM groups. RESULTS: A total of 136 non-target residual plaques were found in 101 patients (27, 30, and 44 in the NGT, IGT, and DM groups, respectively). The size of the lipid core expressed as the mean angle of the lipid arc was significantly greater in the IGT and DM groups than in the NGT group (163.0 ± 58.7°, 170.1 ± 59.3°, and 130.9 ± 37.7°, respectively, P < 0.05). The fibrous cap covering the lipid core was significantly thinner in the IGT group than in the NGT group (77.0 ± 23.4 μm vs. 105.6 ± 47.0 μm, P = 0.040). CONCLUSION: The coronary plaques in CAD patients are more vulnerable when having IGT compared to those with NGT, and similar to those with DM. This finding may explain the high risk of cardiovascular events in CAD patients with IGT.

Discussion

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Cite This Study

Suzuki et al. (2016) conducted a cross-sectional in Coronary artery disease (n=101). Impaired glucose tolerance vs. Normal glucose tolerance was evaluated on Mean angle of the lipid arc (p=0.039). In patients with coronary artery disease, impaired glucose tolerance was associated with a significantly larger mean lipid arc (163.0° vs 130.9°) and thinner fibrous cap (77.0 μm vs 105.6 μm) compared to normal glucose tolerance.

synapsesocial.com/papers/6aa2785481c14275e1240956 https://doi.org/10.1371/journal.pone.0167645

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Plaque Characteristics in Coronary Artery Disease Patients with Impaired Glucose Tolerance

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Plaque Characteristics in Coronary Artery Disease Patients with Impaired Glucose Tolerance

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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