The Impact of Glucose Control on Coronary Plaque Composition in Patients With Diabetes Mellitus

Abstract

Background. Patients with diabetes mellitus (DM) are known to have large necrotic core in their coronary plaque compared to non-DM patients. We assessed coronary plaque composition in patients with angina and with/without DM according to glucose control. Methods. Study subjects consisted of 114 non-DM patients, 14 well-controlled DM patients (hemoglobin A1c [HbA1c] <7.0%), and 37 poorly controlled DM patients (HbA1c >= 7%) who underwent virtual histology intravascular ultrasound (VH-IVUS) examinations of culprit lesions. Results. The DM patients had longer lesion length (20.2 +/- 7.8 mm vs 17.0 +/- 7.3 mm; P=.013) than non-DM patients. The plaque volume was highest in the poorly-controlled DM patients (188.9 +/- 92.6 mm(3)) compared with the non-DM patients (144.1 +/- 92.3 mm3; P=.011) and the well-controlled DM patients (151.7 +/- 82.4 mm3; P=.194). The well-controlled DM patients had less dense calcium (0.33 +/- 0.14 mm(3)/mm vs 0.71 +/- 0.60 mm(3)/mm; P=.020) and less necrotic core (0.71 +/- 0.48 mm(3)/mm vs 1.30 +/- 0.94 mm(3)/mm; P=.029) than the poorly- controlled DM patients and had similar amounts of dense calcium and necrotic core with non-DM patients, whereas fibrous and fibro-fatty volume showed no significant differences among the groups. Conclusion. Coronary plaque composition and plaque volume in well-controlled DM patients are similar to those in non-DM patients and both groups had less dense calcium and necrotic core volume than the poorly- controlled DM patients. These findings suggest hyperglycemia control is important in DM patients with angina. J INVASIVE CARDIOL 2013; 25(3): 137-141