Variance Makes a Difference: Daily Glucose Fluctuation and Coronary Plaque Vulnerability | Journal Scan
What is the relationship between glucose fluctuation and coronary plaque properties, as evaluated by continuous glucose monitoring (CGM) and virtual histology intravascular ultrasound (VH-IVUS), respectively?
This was a prospective study of 70 consecutive patents who underwent percutaneous coronary intervention (PCI) for coronary artery disease (CAD) from June 2012 to May 2014. Patients with acute coronary syndrome were excluded. Eligible patients had a low-density lipoprotein cholesterol level <120 mg/dl under statin treatment or <100 mg/dl without statin therapy. Patients were divided into those with and without diabetes mellitus. Subcutaneous interstitial glucose levels were monitored over a period of 3 consecutive days using the CGM system iPRO2 (Medtronic, Northridge, CA). After the CGM examination, all patients underwent cardiac catheterization with PCI. The CGM software calculated mean amplitude of glycemic excursions (MAGE). VH-IVUS was used to determine plaque properties in culprit and nonculprit lesions; the volume percentage of necrotic core within the plaque (%NC) and the presence of thin-cap fibroatheroma (TCFA) were evaluated.
A total of 165 lesions were evaluated in 70 patients (40 diabetic and 30 nondiabetic patients). When %NC was tested for simple linear correlations against markers of glucose control and other laboratory variables, the strongest correlation was found between %NC and MAGE (r = 0.490; p < 0.001). A generalized linear mixed-effect model revealed that MAGE was the only predictor of the presence of a TCFA (odds ratio, 1.037; 95% confidence interval, 1.010-1.065; p = 0.007).
Among CAD patients with dyslipidemia, daily glucose fluctuation is an important predictor of plaque components, and is the only independent risk factor for the progression of necrotic core within the coronary plaque and formation of TCFA.
The limitations of this small, single-center experience aside, the authors provide a valuable analysis in which they establish the potential role of daily glucose fluctuation in predicting coronary plaque vulnerability. Further studies should investigate the direct effect of glucose fluctuation on plaque vulnerability (by including only patients with more strictly controlled dyslipidemia) and establish a practical approach for detecting and managing glucose fluctuation as strategies to reduce plaque vulnerability.
Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and Coronary Artery Disease, Interventions and Imaging, Echocardiography/Ultrasound
Keywords: Cardiac Catheterization, Cholesterol, Coronary Artery Disease, Coronary Disease, Diabetes Mellitus, Dyslipidemias, Glucose, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipoproteins, LDL, Metabolic Syndrome X, Percutaneous Coronary Intervention, Plaque, Atherosclerotic, Prospective Studies, Risk Factors, Ultrasonography, Interventional
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