Effect of Daily Glucose Fluctuation on Coronary Plaque Vulnerability in Patients Pre-Treated With Lipid-Lowering Therapy A Prospective Observational Study
Effect of Daily Glucose Fluctuation on Coronary Plaque Vulnerability in Patients Pre-Treated With Lipid-Lowering Therapy A Prospective Observational Study
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DOI：
10.1016/j.jcin.2014.11.025
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发表时间：
2015-05-01
影响因子：
11.3
通讯作者：
Hirata, Ken-ichi
中科院分区：
文献类型：
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作者：
Kuroda, Masaru;Shinke, Toshiro;Hirata, Ken-ichi
本研究旨在研究每日血糖波动对接受降脂治疗的冠心病（CAD）患者冠状动脉斑块性质的影响。背景越来越多的证据表明，血糖波动作为血脂异常以外的剩余风险，方法本前瞻性研究纳入70例冠心病患者，经皮冠状动脉介入治疗，低密度脂蛋白胆固醇水平在他汀类药物治疗下< 120 mg/dl或在未使用他汀类药物时< 100 mg/dl。通过测量血糖波动的平均幅度（法师）分析每日血糖波动。虚拟组织学血管内超声的罪犯和非罪犯病变中的斑块属性进行了评估，并在斑块内的坏死核心的体积百分比（%NC）和存在的薄帽纤维粥样硬化evaluated.Results在总，165病变进行了评价70例（40糖尿病和30 nondiabetic患者）。% NC与法师有良好的相关性（r = 0.490，p < 0.001）。线性混合效应模型显示，法师对% NC具有最强的效应（系数β = 0.080 +/- 0.020 [标准误差]，p < 0.001）。广义线性混合效应模型显示，法师是唯一的独立预测存在的薄帽纤维粥样硬化（比值比：1.037; 95%置信区间：1.010至1.065; p = 0.007）。结论每日血糖波动可能有影响冠状动脉斑块的脆弱性与冠心病患者的降脂治疗预处理。进一步的研究应该解决在CAD患者普遍使用他汀类药物的时代早期检测和控制血糖波动的基本原理。(C)2015年美国心脏病学院基金会。
OBJECTIVES This study sought to investigate the effect of daily glucose fluctuation on coronary plaque properties in patients with coronary artery disease (CAD) pre-treated with lipid-lowering therapy.BACKGROUND There is growing evidence that glucose fluctuation, as a residual risk apart from dyslipidemia, is an important factor contributing to the development of CAD.METHODS This prospective study enrolled 70 consecutive CAD patients who were referred for percutaneous coronary intervention and whose low-density lipoprotein cholesterol level was < 120 mg/dl under statin treatment or < 100 mg/dl without statins. Daily glucose fluctuation was analyzed by measuring the mean amplitude of glycemic excursion (MAGE). The plaque properties in the culprit and nonculprit lesions were assessed by virtual histology intravascular ultrasound, and the volume percentage of necrotic core within the plaque (%NC) and the presence of thin-cap fibroatheroma were evaluated.RESULTS In total, 165 lesions were evaluated in 70 patients (40 diabetic and 30 nondiabetic patients). % NC was well correlated with MAGE (r = 0.490, p < 0.001). A linear mixed effect model showed that MAGE had the strongest effect on % NC (coefficient beta = 0.080 +/- 0.020 [standard error], p < 0.001). The generalized linear mixed effect model revealed that MAGE was the only independent predictor of the presence of thin-cap fibroatheroma (odds ratio: 1.037; 95% confidence interval: 1.010 to 1.065; p = 0.007).CONCLUSIONS Daily glucose fluctuation may have an effect on coronary plaque vulnerability in patients with CAD pre-treated with lipid-lowering therapy. Further investigations should address the rationale for the early detection and control of glucose fluctuation in the era of universal statin use for CAD patients. (C) 2015 by the American College of Cardiology Foundation.