Effect of daily glucose fluctuation on coronary plaque vulnerability in patients pre-treated with lipid-lowering therapy: A prospective observational study

Masaru Kuroda, Toshiro Shinke, Kazuhiko Sakaguchi, Hiromasa Otake, Tomofumi Takaya, Yushi Hirota, Daisuke Sugiyama, Masayuki Nakagawa, Hirotoshi Hariki, Takumi Inoue, Tsuyoshi Osue, Yu Taniguchi, Masamichi Iwasaki, Ryo Nishio, Hiroto Kinutani, Akihide Konishi, Noritoshi Hiranuma, Hachidai Takahashi, Daisuke Terashita, Ken Ichi Hirata

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Abstract

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 β = 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.

Original languageEnglish
Pages (from-to)800-811
Number of pages12
JournalJACC: Cardiovascular Interventions
Volume8
Issue number6
DOIs
Publication statusPublished - 2015 May 1

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Keywords

  • continuous glucose monitoring
  • glucose fluctuation
  • mean amplitude of glycemic excursion
  • thin-cap fibroatheroma
  • virtual histology intravascular ultrasound

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Kuroda, M., Shinke, T., Sakaguchi, K., Otake, H., Takaya, T., Hirota, Y., Sugiyama, D., Nakagawa, M., Hariki, H., Inoue, T., Osue, T., Taniguchi, Y., Iwasaki, M., Nishio, R., Kinutani, H., Konishi, A., Hiranuma, N., Takahashi, H., Terashita, D., & Hirata, K. I. (2015). Effect of daily glucose fluctuation on coronary plaque vulnerability in patients pre-treated with lipid-lowering therapy: A prospective observational study. JACC: Cardiovascular Interventions, 8(6), 800-811. https://doi.org/10.1016/j.jcin.2014.11.025