Abstract 4738: Plaque Regression in Patients With Diabetes Mellitus After Rosuvastatin Treatment: A Serial Intravascular Ultrasound Analysis From the COSMOS Study
Background and Purpose: It has been documented that patients with DM have a higher cardiac event rate than those without DM even after lipid-lowering therapy. However, its exact mechanism from the viewpoints of plaque progression or regression was still unclear. The COSMOS study was a multicenter study with use of intravascular ultrasound (IVUS) indicated plaque regression in Japanese patients with chronic coronary disease after 76-week rosuvastatin treatment. The purpose of this study was to clarify the effect of impaired glycemic homeostasis in plaque regression induced by rosuvastatin. A multivariate analysis was performed as a sub-analysis from the COSMOS study.
Methods and Results: The multivariate analysis revealed that the levels of HbA1c as well as plaque volume at the baseline were the major determinants of plaque regression. Therefore, of patients enrolled to the COSMOS study which was conducted to reveal the effect of rosuvastatin (2.5 to 20 mg/day) on plaque regression, 32 patients with poorly-controlled HbA1c level (≥6.5%: group A) and 94 patients with well-controlled one (<6.5%: group B) were compared regarding plaque volume (PV), lumen volume (LV) and vessel volume (VV). Low-density lipoprotein cholesterol (LDL-C) levels decreased similarly from baseline by 36% and 39.5% in group A and B (A vs. B: p=0.28), respectively. High-density lipoprotein cholesterol (HDL-C) levels increased 15.6% in group A and 21.2% in group B (A vs. B: p=0.07). Although IVUS showed that significant plaque reduction was found in only group B (A: 74±36 to 71±34 mm3, p=0.77 and B: 71±39 to 65±34 mm3, p<0.0001, A vs. B: p<0.05), LV increased significantly in both group (A: 12.6%, p<0.0001, vs. baseline, B: 5.4%, p=0.0008), whereas VV increased significantly only in group A(positive remodeling)but not in group B (A:+5.2%, p=0.04, vs. baseline, B:−0.8%, p=0.49.)
Conclusions: Although comparable reduction of LDL-C level and increase in HDL-C level by rosuvastatin for both groups, less regression but with positive remodeling was depicted in patients with poorly-controlled HbA1c level. Therefore, it would be clinically important to vigorously control HbA1c level during statin therapy in patients with stable coronary disease.