Abstract 11180: Attenuated Anti-atherogenic Effects by Statins in Diabetic Patients in Comparison with Non-diabetic Patients; Non-invasive Quantitative Analysis of Coronary Hyperintense Plaques Detected by Non-contrast T1-weighted Magnetic Resonance Imaging

Abstract

Background: The recent meta-analysis addressed the controversy surrounding the diabetogenic effects of statins, which reignite clinical concern the increased risk of its associated cardiovascular complications. We previously showed that coronary high intensity plaques (HIPs) on non-contrast T1-weighted imaging (T1WI) represent vulnerable plaques. Our goal was to evaluate the impact of intensive lowering of low-density lipoprotein cholesterol (LDL-C) levels by statins on the progression of coronary atherosclerosis in patients with and without diabetes mellitus (DM) using cardiac magnetic resonance (CMR).

Methods: We examined coronary plaques in 223 consecutive coronary artery disease patients at baseline and after 1 year of intensive statin therapy (target LDL-C <80 mg/dl) using serial non-contrast T1WI and computed tomography (CT) angiography. Changes in coronary remodeling index, plaque area based on CT, and signal intensity of HIPs on T1WI were compared in subjects with (n=104) and without DM (n=119). HIP was defined as present when the signal intensity of plaque to myocardium ratio (PMR) was greater than 1.0.

Results: Following 1-year treatment, there was no significant difference in LDL-C levels between diabetic and non-diabetic patients (68±9 mg/dl vs. 69±15 mg/dl). Diabetic patients had larger plaque areas (12.7±2.7 mm² vs. 9.3±3.3 mm², P<0.001) and higher remodeling indexes (1.22±0.07 vs. 1.14±0.04, P<0.001). A stronger positive correlation was observed between PMR and glycated hemoglobin (r=+0.41, P=0.012) than LDL-C, whereas negative correlation was seen in HDL-C (r=-0.34, P=0.037). Importantly, more rapid progression of plaque area (+2.7±0.5% vs. +1.0±0.3%, P<0.001) and increases in PMR (+17.1±3.1% vs. −23.2±10.1% P<0.0001) were observed in diabetic patients compared with non-diabetic patients.

Conclusions: Statin-induced anti-atherogenic effects were attenuated in diabetic patients compared to non-diabetic patients.