Phenotypic Features of Coronary Atheroma in Diabetic and Nondiabetic Patients With Low-Density Lipoprotein Cholesterol <55 mg/dL.
Phenotypic Features of Coronary Atheroma in Diabetic and Nondiabetic Patients With Low-Density Lipoprotein Cholesterol <55 mg/dL.
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低密度脂蛋白胆固醇<55 mg/dL 的糖尿病和非糖尿病患者冠状动脉粥样硬化的表型特征。
DOI：
10.1016/j.jcmg.2022.02.005
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Noguchi T.
中科院分区：
文献类型：
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作者：
Iwai T;Kataoka Y;Nicholls SJ;Puri R;Murata S;Nishimura K;Murai K;Kitahara S;Sawada K;Matama H;Honda S;Takagi K;Fujino M;Yoneda S;Otsuka F;Nishihira K;Asaumi Y;Miyamoto Y;Yasuda S;Noguchi T.
血管内成像显示，随着斑块钙化量的增加，动脉粥样硬化斑块物质减少，低密度脂蛋白胆固醇（LDL-C）降低，部分导致动脉粥样硬化性心血管疾病风险降低。尽管有这种有益的效果，2型糖尿病患者仍然表现出持续的心血管风险，伴随着他们脆弱的动脉粥样硬化疾病。这些糖尿病相关的临床特征表明需要更强化的抗动脉粥样硬化治疗。最近的指南提倡LDLC< 55 mg/dL作为动脉粥样硬化性心血管疾病受试者的治疗目标。然而，这种更严格的LDL-C控制是否对糖尿病动脉粥样硬化有益仍不确定。因此，我们研究了LDL-C< 55 mg/dL的糖尿病和非糖尿病受试者的近红外光谱（NIRS）成像上的斑块和钙化斑块特征。本研究分析了REASSURE-NIRS（近红外光谱法评价可变富脂斑块的病理生理表型）多中心登记研究（NCT 04864171）中523例受试者（246例糖尿病患者[264处病变]，277例非糖尿病患者[293处病变]）的557处病变。本研究已获得国家脑心血管中心（M30-084-4）和宫崎医学会医院（2020-43）的机构审查委员会批准。评估靶病变的最大4-mm脂核负荷指数（maxLCBI 4 mm）和钙指数（CaI）。根据声学阴影的程度（0/4无钙，1/4钙化弧< 90，2/4钙化弧90-180，3/4钙化弧180-270，4/4钙化弧$270）分析每1 mm横截面的钙等级。CaI计算如下2：
Intravascular imaging has shown a reduction of lipidic plaque materials with an increased amount of plaque calcification with achieving lower low-density lipoprotein cholesterol (LDL-C), which partly results in a reduction of atherosclerotic cardiovascular disease risks. Despite this beneficial effect, patients with type2 diabetes still exhibit continuing cardiovascular risks, accompanied by their vulnerable forms of atherosclerotic disease. These diabetes-related clinical features suggest the need for more intensive antiatherosclerotic therapies. Recent guidelines advocate LDLC< 55 mg/dL as a therapeutic goal in subjects with atherosclerotic cardiovascular disease. 1 However, whether this stricter LDL-C control is beneficial for diabetic atherosclerosis remains uncertain. Therefore, we investigated lipidic and calcific plaque features on near-infrared spectroscopy(NIRS) imaging in diabetic and nondiabetic subjects in association with LDL-C< 55 mg/dL. This study analyzed 557 lesions in 523 subjects (246 diabetic patients [264 lesions], 277 nondiabetic patients [293 lesions]) from the REASSURE-NIRS (REvelation of PAthophySiological PhenotypeS of VUlneRable Lipid-Rich PlaquE on Near-InfraRed Spectroscopy) multicenter registry (NCT04864171). This study was approved by the institutional review board of the National Cerebral and Cardiovascular Center (M30-084-4) and the Miyazaki Medical Association Hospital (2020-43). Maximum 4-mm lipidcore burden index (maxLCBI4mm) and calcium index (CaI) at target lesions were evaluated. Every 1-mm cross-sectional calcium grade was analyzed according to the degree of acoustic shadowing (0 ¼ no calcium, 1 ¼ calcification arc< 90, 2 ¼ calcification arc 90-180, 3 ¼ calcification arc 180-270, and 4 ¼ calcification arc $270). CaI was calculated as follows 2: