Abstract 17291: Impact of Diabetes Mellitus on Atherosclerotic Plaque Lipid Regression: Results from the Prospective, Randomized YELLOW Trial
Background: Diabetes mellitus (DM) is associated with changes in atherosclerotic plaque composition that increase cardiovascular risk. The benefits of statins are significant in high-risk patients with DM. Whether or not these benefits are attributable to differential modulation of lipid-rich atherosclerotic plaque between DM and non-DM patients is unknown.
Methods: In the prospective YELLOW (The Reduction in Yellow Plaque by Aggressive Lipid lowering Therapy) trial we randomized 87 patients with multivessel coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) and one other obstructive (fractional flow reserve [FFR] ≤0.8) non-target lesion (NTL), to aggressive (rosuvastatin 40 mg daily) or standard-of-care lipid lowering therapy. The NTLs were evaluated for lipid content by near infrared spectroscopy (NIRS, measured as lipid-core burden index over 4 mm or LCBI-4), and for plaque morphology by intravascular ultrasound (IVUS). Changes in FFR, LCBI, and IVUS were documented after 7 weeks.
Results: Baseline clinical, demographic and lipid parameters were well balanced between those with (n=41) and without (n=46) DM. The mean reduction in LCBI-4 from baseline to follow-up was greater in non-DM (406.9 vs. 300.4, p=0.002) compared to DM (471.1 vs. 427.5, p=0.13 Figure). Analogously in non-diabetics, aggressive versus usual statin therapy was associated with a larger percent reduction in LCBI-4 (-36.3% vs. 9.2%, p=0.04) compared to those with DM (-18.4% vs. -2.4%, p=0.23). There were no differences in FFR or IVUS parameters between groups.
Conclusions: While aggressive statin therapy reduced lipid content in obstructive coronary lesions in the YELLOW trial, results were attenuated in those with vs. without DM. These results suggest an impaired pattern for short-term regression in diabetic atherosclerosis.
- © 2012 by American Heart Association, Inc.