Abstract 10453: Impact of Diabetes Duration on Atheroma Progression in Diabetic Patients with Coronary Artery Disease: Insights From Serial Intravascular Ultrasound
Background: Diabetes duration is thought to contribute to more extensive coronary atherosclerotic lesions and increased risks for cardiovascular events. However, it remains to be fully elucidated about the association between diabetes duration and atheroma progression in diabetic patients with coronary artery disease (CAD).
Methods: 360 diabetic patients with angiographic CAD underwent serial intravascular ultrasound imaging to monitor changes in atheroma burden in the PERISCOPE trial. These patients were stratified according to the median value of diabetes duration (5.5 years). Clinical characteristics and disease progression were compared in patients with diabetes duration <5.5 years and ≥5.5 years.
Results: The established medical therapies were highly used in the study subjects (89% statin, 93% aspirin, 80% beta-blocker, 73% ACE inhibitor, 64% metformin, 50% pioglitazone). Patients with longer diabetes duration were older (61 v. 58 years, p=0.002), more likely to have a history of peripheral artery disease (16 v. 6%, p=0.003), higher baseline HbA1c (7.5±0.9 v. 7.3±1.0%, p=0.04) and glucose (155±49 v. 141±32mg/dL, p=0.005) levels. These patients were also more likely to be treated with insulin (32 v. 14%, p<0.001). Although baseline percent atheroma volume (PAV) was similar (41.2±8.47 v. 39.7±8.76, p=0.11), patients with longer diabetes duration showed more disease progression (change in PAV: 0.57±0.20 v. 0.04±0.20, p=0.05). Although intensive control of LDL-C below 100mg/dL slowed disease progression, this efficacy was attenuated in patients with longer diabetes duration (Figure).
Conclusions: Despite use of various established medical therapies, longer diabetes duration is associated with greater disease progression. These findings support the need for more intensification of strict risk factor control in patients with a longer history of diabetes.
- © 2011 by American Heart Association, Inc.