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Abnormal Glucose Regulation Is Associated With Lipid-Rich Coronary Plaque

Relationship to Insulin Resistance

Tetsuya Amano, MD, PhD^_*,_*, Tatsuaki Matsubara, MD, PhD, Tadayuki Uetani, MD, PhD^_*, Michio Nanki, MD, PhD^_*, Nobuyuki Marui, MD, PhD^_*, Masataka Kato, MD^_*, Tomohiro Yoshida, MD^_*, Kosuke Arai, MD^_*, Kiminobu Yokoi, MD^_*, Hirohiko Ando, MD^_*, Soichiro Kumagai, MD^_*, Hideki Ishii, MD, Hideo Izawa, MD, PhD, Nigishi Hotta, MD, PhD^_*, Toyoaki Murohara, MD, PhD

^_* Department of Cardiology, Chubu-Rosai Hospital, Nagoya, Japan
Department of Internal Medicine, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

^_* Reprint requests and correspondence: Dr. Tetsuya Amano, Department of Cardiology, Chubu-Rosai Hospital, Kohmei 1-10-6, Minato-ku, Nagoya, 455-8530, Japan. (Email: amanot{at}med.nagoya-u.ac.jp).

Objectives: This study sought to determine lipid and fibrous volume of coronary atherosclerotic plaques in subjects with abnormal glucose regulation (AGR) by integrated backscatter (IB) intravascular ultrasound (IVUS) during percutaneous coronary intervention.

Background: Abnormal glucose regulation, including impaired glucose regulation (IGR) and diabetes mellitus (DM), has emerged as an important determinant of cardiovascular risk. We hypothesized that AGR would be associated with coronary plaque instability.

Methods: Conventional intravascular ultrasound and IB-IVUS using a 40-MHz (motorized pullback 1 mm/s) intravascular catheter was performed in 172 consecutive patients. The percentage of fibrous area and the percentage of lipid area were automatically calculated by IB-IVUS. Three-dimensional analysis of IB-IVUS images was performed to determine the percentage of lipid volume (%LV) and fibrous volume (%FV). Following the World Health Organization criteria, the subjects were classified into the DM group, the IGR group, and the normal glucose regulation group. The cutoff point for the lipid-rich plaque was defined as %LV >44% or %FV <52%, which was the 75th percentile of %LV or the 25th percentile of %FV in this study population. Insulin resistance (IR) was defined as the homeostasis model assessment of insulin resistance (HOMA-IR).

Results: There were no significant differences in the baseline characteristics except for glucometabolic parameters. The conventional IVUS analysis indicated that the DM group had a significantly increased plaque volume (and percent plaque volume). In the IB-IVUS analysis, as compared with the normal glucose regulation group, the DM and the IGR groups showed a significant increase in %LV (36 ± 14% and 37 ± 13% vs. 29 ± 14%, p = 0.02) and a significant decrease in %FV (59 ± 11% and 58 ± 11% vs. 64 ± 11%, p = 0.03). The lipid-rich plaque rate was significantly associated with an increasing HOMA-IR in the tertile (p = 0.008). On logistic regression analysis after adjusting for confounding and coronary risk factors, the DM group (odds ratio 3.52, 95% confidence interval 1.13 to 11.0, p = 0.03) and the IGR group (odds ratio 3.92, 95% confidence interval 1.13 to 13.6, p = 0.03) were significantly associated with the lipid-rich plaque.

Conclusions: Coronary lesions in patients with AGR are associated with more lipid-rich plaque content, which may be related to the increased IR in these patients.

Abbreviations and Acronyms   %FV = percentage of fibrous volume   %LV = percentage of lipid volume   ACS = acute coronary syndrome   AGR = abnormal glucose regulation   CSA = cross-sectional area   CVD = cardiovascular disease   DM = diabetes mellitus   EEM = external elastic membrane   HOMA-IR = homeostasis model assessment of insulin resistance   IB-IVUS = integrated backscatter intravascular ultrasound   IGR = impaired glucose regulation   IR = insulin resistance   LCSA = lumen cross-sectional area   NGR = normal glucose regulation   OGTT = oral glucose tolerance test   PCI = percutaneous coronary intervention

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