Abstract 16129: Low HDL is the only Major Risk Factor Independently Associated with Increased Inflammation in Diabetic Coronary Artery Disease Patients after Percutaneous Coronary Intervention as Measured by 18F-fluorodeoxyglucose Positron-Emission Tomography

Abstract

Introduction: Vascular inflammation, increased in diabetic patients, is a critical determinant of increased risk for cardiovascular events. However, the association of major risk factors with inflammation in diabetes patients remains unknown.

Aim: We investigated the association of baseline risk factor control and vascular inflammation in post coronary revascularization (PCI) diabetic CAD patients treated with contemporary therapies.

Methods: Diabetic CAD patients (n = 52) similar in clinical characteristics to patients in the Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease (FREEDOM) Trial were prospectively imaged via ¹⁸F- fluorodeoxyglucose positron-emission tomography (FDG-PET) between 21-40 days post PCI. FDG-PET images were analyzed to determine the mean of the max (MnMax) target to background ratio (TBR) in the carotid arteries. A TBR > 1.6 has been previously established as elevated. Clinical and laboratory characteristics were correlated to TBR values with univariate testing and multivariate linear regression.

Results: Mean MnMax TBR was 2.15 ± 0.4 in the carotid arteries. Average age was 60.2 years and 83% were men. Age (r= 0.32, p = 0.03) and male gender (p = 0.003) were positively correlated with MnMax TBR. The mean risk factor values were systolic blood pressure: 129 ± 13 mmHg, HgbA1c: 7.4 ± 1.3%, LDL-C: 67 ± 24 mg/dL, and HDL-C: 38 ± 10 mg/dL. Nearly all patients were treated with lipid lowering agents (96%), including statin therapy in 90%. An HDL-C <40 mg/dL was strongly associated with increased inflammation (p = 0.02). No significant differences in inflammation existed based on indication for PCI, prior event, or any other major risk factor. After adjustment for age, gender, and BMI; HDL-C <40 remained an independent predictor for increased carotid inflammation (p = 0.02).

Conclusion: In this cohort of risk factor optimized diabetic CAD patients imaged by FDG-PET with high baseline MnMax TBR, an HDL-C < 40 is a strong independent predictor of increased inflammation. Despite a high utilization of statin therapy in this cohort, low HDL-C levels are a biomarker for increased vascular inflammation in diabetes patients, which supports its role in modulating inflammation.