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(Circulation. 2000;102:2180.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Coronary Composition and Macrophage Infiltration in Atherectomy Specimens From Patients With Diabetes Mellitus
From the Gill Heart Institute, University of Kentucky, Lexington, Ky (P.R.M.); the Cardiac Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (I.F.P., M.N.L.); the Cardiovascular Institute (V.F., J.T.F.) and the Department of Pathology (J.T.F.), The Mount Sinai School of Medicine, New York, NY; the Department of Internal Medicine, Mount Sinai Medical Center, Miami, Fla (A.M.M.); and the Excelsitas Medical Center, Buenos Aires, Argentina (V.H.B.).
Correspondence to Pedro R. Moreno, MD, 111B-CDD, VA Medical Center, Lexington, Kentucky 40511. E-mail pmoreno{at}pop.uky.edu
Background—Lipid-rich, inflamed atherosclerotic lesions are associated with plaque rupture and thrombosis, which are the most important causes of death in patients with diabetes mellitus. This study was designed to quantify lipid composition and macrophage infiltration in the coronary lesions of patients with diabetes mellitus.
Methods and Results—A total of 47 coronary atherectomy specimens from patients with diabetes mellitus were examined and compared with 48 atherectomy specimens from patients without diabetes. Plaque composition was characterized by trichrome staining. Macrophage infiltration was characterized by immunostaining. Clinical and demographic data were similar in both groups. The percentage of total area occupied by lipid-rich atheroma was larger in specimens from patients with diabetes (7±2%) than in specimens from patients without diabetes (2±1%; P=0.01), and the percentage of total area occupied by macrophages was larger in specimens from patients with diabetes (22±3%) than in specimens from patients without diabetes (12±1%; P=0.003). The incidence of thrombus was also higher in specimens from patients with diabetes than in specimens from patients without diabetes (62% versus 40%; P=0.04). Plaque composition, macrophage infiltration, and thrombus were similar in lesions from diabetic patients treated with insulin compared with lesions from patients treated with sulfonylureas or diet.
Conclusions—Coronary tissue from patients with diabetes exhibits a larger content of lipid-rich atheroma, macrophage infiltration, and subsequent thrombosis than tissue from patients without diabetes. These differences suggest an increased vulnerability for coronary thrombosis in patients with diabetes mellitus.
Key Words: atherosclerosis • coronary disease • diabetes mellitus • plaque
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