Abstract 10877: Progression of Coronary Atherosclerosis in Diabetic Patients With Vulnerable Plaques: A Malignant Combination Underlying Adverse Cardiovascular Outcomes

Abstract

Backgrounds: Diabetic patients exhibit extensive burden and progression of atherosclerotic plaque, associated with adverse cardiovascular outcomes. The relationship between vulnerable forms of disease and plaque progression in diabetes has not been investigated.

Methods: 1063 patients with angiographic coronary artery disease and focal vulnerable plaques (percent atheroma volume >40%, expansive vascular remodeling, spotty calcification) underwent serial evaluation of atheroma burden in 7 clinical trials of anti-atherosclerotic therapies. Patients with (n=399) and without (n=664) diabetes were compared with regard to disease progression on intravascular ultrasound.

Results: Diabetic patients with VP were more likely to be older (59 v. 58 years, p=0.009), obese (33 v. 31, p<0.001), and more likely to have hypertension (89 v. 78%, p<0.001), dyslipidemia (85 v. 73%, p<0.001), a history of stroke (7 v. 3%, p=0.002) and peripheral vascular disease (10 v. 5%, p=0.002). Diabetic patients exhibited a greater PAV (43.5±7.6% vs. 41.9±7.3%, p=0.001) at baseline. On serial evaluation, while PAV in non-diabetic patients decreased, greater progression of PAV was observed in diabetic patients (0.73±0.31% vs. -0.52±0.29%, p5%: 16 v. 29%, p 5%: 26 v. 20%, p=0.03). Intensive control of LDL-C < 100mg/dL was associated with less atheroma progression, these effects being attenuated in diabetic patients (Figure).

Conclusions: Diabetic patients with vulnerable plaques showed extensive disease, greater atheroma progression and diminished response to anti-atherosclerotic therapies. This supports the need for more intensive risk factor modification in vulnerable patients with diabetes.