Abstract 21440: Greater Progression of Coronary Atherosclerosis in Association with Worsening Degrees of Glycemic Control: Insights From Intravascular Ultrasound
Background: Increasing evidence has demonstrated an association between prediabetic states and adverse cardiovascular outcomes. This analysis sought to characterize serial changes in atheroma burden and arterial wall remodeling in patients with varying degrees of glucose control.
Methods: Patients with angiographic coronary artery disease undergoing serial evaluation of atheroma burden with intravascular ultrasound were stratified according to baseline status of normoglycemia (n=1539), impaired fasting glucose (n=726) and diabetes (n=1085). Groups were compared with regard to clinical characteristics and progression of atherosclerosis and changes in remodeling parameters.
Results: At baseline, diabetic patients harboured more extensive atherosclerosis and luminal constriction. In contrast, patients with impaired fasting glucose were similar to those with normoglycemia. On serial evaluation a trend was observed with increasing disease progression with worsening states of glycemic control. While progression was greatest in diabetic patients, impaired fasting glucose was associated with more accelerated progression than normoglycemia. This was accompanied by constrictive remodeling with lumen contraction in all groups. (Table) In patients with impaired fasting glucose, factors independently associated with disease progression included percentage changes in LDL-C (p=0.047) and HDL-C (p=0.04).
Conclusion: Increasing degrees of poor glucose control is associated with greater progression of coronary atherosclerosis on serial evaluation. Accelerated progression in patients with impaired fasting glucose highlights the need for more intensive modification of lipid factors.
- © 2010 by American Heart Association, Inc.