Abnormal Glucose Regulation Is Associated With Lipid-Rich Coronary PlaqueRelationship 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.
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Figure 1 Comparisons of IB-IVUS Parameters Among the 3 Groups
(A) Percentage of lipid volume (%LV). (B) Percentage of fibrous volume (%FV). (C) Percentage of high signal volume. Coronary arteries in patients with impaired glucose resistance (IGR) and diabetes mellitus (DM) significantly increased in %LV (37 ± 13% and 36 ± 14% vs. 29 ± 14%, p = 0.02) and significantly decreased in %FV (58 ± 11% and 59 ± 11% vs. 64 ± 11%, p = 0.03) compared with those with normal glucose regulation (NGR). ANOVA = analysis of variance; IB-IVUS = integrated backscatter intravascular ultrasound.
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Figure 2 The Lipid-Rich Plaque Rate According to the Tertile of HOMA-IR
Insulin resistance (IR) was defined from the homeostasis model assessment of insulin resistance (HOMA-IR). The cutoff point for the lipid-rich plaque was defined as percentage of lipid volume (%LV) >44% or percentage of fibrous volume (%FV) <52%, which was the 75th percentile of %LV or the 25th percentile of %FV in this study population. The lipid-rich plaque rate was significantly associated with an increasing tertile of HOMA-IR (p = 0.008 by analysis of variance [ANOVA]). These results suggest the relationship between IR and greater lipid-rich plaque content.
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Figure 3 Representative Images of Conventional and 2D IB-IVUS Color-Coded Maps of Coronary Artery Plaques
The percentage of lipid area (%LA) and the percentage of fibrous area (%FA) were automatically calculated by IB-IVUS. The %LA and %FA were (top panels) 30% and 68% in patients with the lowest tertile of the HOMA-IR, and (bottom panels) 46% and 49% in patients with the highest tertile of HOMA-IR. Blue = lipid pool; green/yellow = fibrous lesion; red = high signal lesion. 2D = 2-dimensional; other abbreviations as in Figures 1 and 2.
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