Clinical Predictors of Atheroma Progression Despite Optimal Glycemic Control in Early-Stage Diabetic Patients with Coronary Artery Disease: Insight from the DIANA Study
Clinical Predictors of Atheroma Progression Despite Optimal Glycemic Control in Early-Stage Diabetic Patients with Coronary Artery Disease: Insight from the DIANA Study
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DOI：
10.5551/jat.21089
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发表时间：
2014-01-01
影响因子：
4.4
通讯作者：
Miyazaki, Shunichi
中科院分区：
文献类型：
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作者：
Kataoka, Yu;Yasuda, Satoshi;Miyazaki, Shunichi
目的：在Diana(糖尿病和弥漫性冠状动脉狭窄)研究中，评估了降糖治疗对早期糖尿病合并冠心病(CAD)患者的影响，最佳的血糖控制可以减少冠状动脉造影术中的疾病进展。然而，尽管有良好的血糖状态，一些患者继续表现出疾病进展。尽管血糖控制最佳，但与疾病进展相关的因素仍有待阐明。方法：Diana研究是一项前瞻性随机试验，比较了生活方式干预和伏格列波糖或那格列奈治疗对302例糖耐量减低/新诊断糖尿病冠心病患者血管造影的影响。在这些患者中，达到最佳血糖控制的137名冠心病患者根据血管造影上的疾病进展情况进行分层：进展者(n=)和非进展者(n=73)。进行了一系列冠状动脉造影术研究和定量冠状动脉造影术分析以评估疾病进展。结果：尽管取得了最佳的血糖控制，但46%的研究对象观察到动脉粥样硬化进展。进展者的收缩压下降较慢(SBP：P=0.007.0 1)，基线病变总长度减少(Tll：P=0.0 1)。多因素分析显示，SBP升高(p=0.006)、非他汀类药物治疗(p=0.03)和基线Tll(p=0.007)与疾病进展独立相关。结论：残余危险因素有助于早期糖尿病患者冠状动脉粥样硬化的进展，他们的血糖状况有所改善。目前的研究结果强调了在糖尿病早期阶段密集调整多种危险因素以防止动脉粥样硬化进展的必要性。
Aim: In the DIANA (DIAbetes and diffuse coronary NArrowing) study, which evaluated the impact of glucose-lowering therapy in early-stage diabetics with coronary artery disease (CAD), optimal glycemic control resulted in reduced disease progression on angiography. However, despite having a favorable glycemic status, some patients continued to exhibit disease progression. Factors associated with disease progression despite optimal glucose control remain to be elucidated. We sought to investigate clinical characteristics associated with substantial atheroma progression in early-stage diabetic patients with CAD who achieve favorable glycemic control.Methods: The DIANA study is a prospective randomized trial comparing the effects of lifestyle intervention and treatment with voglibose or nateglinide on disease progression on angiography in 302 CAD patients with impaired glucose tolerance/newly diagnosed diabetes. Of these patients, 137 CAD subjects who achieved optimal glycemic control were stratified according to the presence of disease progression on angiography: progressors (n = 64) and non-progressors (n = 73). Serial coronary angiography studies and quantitative coronary angiography analyses were conducted to evaluate disease progression. A multivariate analysis was performed to elucidate factors associated with disease progression.Results: Despite the achievement of optimal glycemic control, atheroma progression was observed in 46% of the study subjects. The progressors exhibited lower decreases in systolic blood pressure (SBP: p=0.007) and reduced baseline total lesion lengths (TLL: p=0.01). The multivariate analysis demonstrated that a greater increase in SBP (p=0.006), treatment without statins (p=0.03) and the baseline TLL (p=0.007) were independently associated with disease progression.Conclusions: Residual risk factors contribute to the progression of coronary atherosclerosis in early-stage diabetics who exhibit improvements in their glycemic status. The present findings underscore the need to intensively modify multiple risk factors during the early diabetic phase in order to prevent atheroma progression.