Abstract 21363: Improving Glycemic Control is Associated with A Beneficial Impact on Progression of Coronary Atherosclerosis: Insights From Intravascular Ultrasound
Background: Measures of glycemic control and insulin sensitivity are associated with cardiovascular outcome in patients with diabetes. However, there is currently no data suggesting that favorable changes in these parameters are associated with cardiovascular benefit.
Methods: 608 patients with diabetes and angiographic coronary artery disease underwent serial evaluation of atheroma burden with intravascular ultrasound in 3 clinical trials. The relationship between changes in measures of glucose control and insulin sensitivity with disease progression was investigated.
Results: Patients (53 years, 66% male, 89% hypertension, 89% statin use) demonstrated an increase of percent atheroma volume (PAV, +0.44±0.11%, p<0.01) and decrease in total atheroma volume (TAV, -2.2±0.75mm3, p<0.01) over a 20-month period. Favorable changes in HBA1c (-0.20%, p<0.01), insulin (-1.8mU/L, p<0.01) and HOMA-IR score (-0.54, p=0.07) were observed. A significant correlation was observed between changes in PAV and HBA1c (p=0.03), but not fasting blood glucose (p=0.47), insulin (p=0.93) or HOMA-IR (p=0.37). Similar relationships were observed with regard to changes in TAV. A beneficial impact on progression of PAV (+0.30±0.14 v +0.55±0.17%, p=0.25) and TAV (-0.2±1.7 v -3.7±1.6 mm3, p=0.03) was observed in those patients whose HBA1c decreased. In addition, patients who underwent regression of PAV demonstrated a greater benefit in terms of change in HBA1c (-0.32±1.04 v -0.06±1.26%, p=0.03). In patients with the most effective reduction in HBA1c, a greater reduction in progression of PAV was observed in patients who also underwent greater reductions in triglyceride (0±0.14 v 0.35±0.16%, p<0.05) and greater increase in HDL cholesterol (-0.13±0.14 v 0.47±0.16%, p<0.05).
Conclusion: Beneficial changes in longstanding glycemic control, but not insulin sensitivity, are associated with less progression of coronary atherosclerosis in patients with diabetes. The combination of favorable changes in both glucose control with markers of atherogenic dyslipidemia are associated with the greatest benefit. This suggests that novel anti-diabetic therapies, that target multiple metabolic parameters may have a beneficial impact on atherosclerotic plaque.
- © 2010 by American Heart Association, Inc.