Plaque stabilization by intensive LDL-cholesterol lowering therapy with atorvastatin is delayed in type 2 diabetic patients with coronary artery disease-Serial angioscopic and intravascular ultrasound analysis
Plaque stabilization by intensive LDL-cholesterol lowering therapy with atorvastatin is delayed in type 2 diabetic patients with coronary artery disease-Serial angioscopic and intravascular ultrasound analysis
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患有冠状动脉疾病的 2 型糖尿病患者通过阿托伐他汀强化低密度脂蛋白胆固醇降低治疗实现斑块稳定会延迟 - 系列血管镜和血管内超声分析
DOI：
10.1016/j.jjcc.2013.01.010
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
A. Hirayama and K. Kodama
中科院分区：
文献类型：
--
作者：
T. Takayama;T. Hiro;Y. Ueda;J. Honye;S. Komatsu;O. Yamaguchi;Y. Li;J. Yajima;K. Takazawa;S. Nanto;S. Saito ;A. Hirayama and K. Kodama
糖尿病（DM）是心血管事件的主要危险因素。本研究采用血管内超声（IVUS）和冠状动脉血管镜检查，比较DM和非DM（nDM）患者他汀类药物引起的斑块特征变化。研究了11例DM患者和28例nDM患者，DM和nDM患者在第28周和第80周时低密度脂蛋白胆固醇水平较基线水平显著下降，下降程度相似（p<0.001）。两组中DM和nDM黄色斑块的平均血管镜检查颜色等级在基线时相似，在第80周时较基线显著降低，但是，DM的血管镜检查颜色等级较基线的平均变化未显著降低，并且在第28周时平均血管镜检查颜色显著高于nDM（1.34 vs. 1.00，p<0.05）。IVUS显示两组斑块体积均减少（P<0.01），但DM组在80周时斑块体积与基线相比无统计学差异（P> 0.05）。然而，在第80周，DM组和nDM组之间的黄度变得相当。这些结果表明，糖尿病患者应接受阿托伐他汀强化降脂治疗至少80周，以稳定易损斑块。
BACKGROUNDDiabetes mellitus (DM) is a major risk factor for cardiovascular events. The study purpose was to compare DM and non-DM (nDM) patients in terms of statin-induced change of plaque characteristics using intravascular ultrasound (IVUS) and coronary angioscopy.METHODSPatients with coronary artery disease and hypercholesterolemia who were enrolled to the TWINS were selected and classified into two groups: DM group and nDM group. Eleven DM patients and 28 nDM patients were studied.RESULTSLow-density lipoprotein cholesterol levels decreased significantly to a similar extent at weeks 28 and 80 from baseline in DM and nDM (p<0.001). The mean angioscopic color grades of yellow plaques in DM and nDM were similar at baseline and significantly decreased at week 80 from baseline in both groups, however, the mean change of angioscopic color grade from baseline in DM were not significantly decreased and the mean angioscopic color was significantly higher than that in nDM (1.34 vs. 1.00, p<0.05) at week 28. IVUS showed plaque volume reduction in both groups (p<0.01) except at week 80 in DM group, which was not statistically significant different compared to the baseline.CONCLUSIONIn DM patients, plaque volume regression by atorvastatin was shown to be attenuated, and its color improvement was significantly delayed. However, the yellowness became comparable between DM and nDM groups at week 80. These results indicate that patients with DM should be treated by intensive lipid-lowering therapy with atorvastatin for at least 80 weeks to stabilize vulnerable plaque.