Abstract 14775: Differential Responses of Atheroma Progression to Blood Pressure Lowering in Patients with and without Diabetes
Background: High blood pressure is a major risk factor for atherosclerotic cardiovascular diseases in diabetic and non-diabetic individuals. While blood pressure lowering has been demonstrated to slow progression of coronary atherosclerosis, the relative impact in the presence and absence of diabetes has not been established.
Methods: 4976 patients with angiographic coronary artery disease underwent serial evaluation of atheroma volume by intravascular ultrasound. Changes in percent atheroma volume (PAV) and total atheroma volume were compared in patients with (n=1442) and without (n=3534) diabetes, stratified according to achieved systolic blood pressure (SBP) levels.
Results: Non-diabetics who achieved lower SBP level were more likely to be younger (p<0.001), male (p=0.001) and have a history of myocardial infarction (p<0.001). On serial evaluation, lower on-treatment SBP level was associated with less atheroma progression in non-diabetics (Table). In particular, lowering SBP < 120mmHg was associated with PAV regression. In diabetic patients, those who achieved SBP<120mmHg were also more likely to be younger (p<0.001) and have a history of myocardial infarction (p<0.001). In contrast to non-diabetics, there were no significant differences in atheroma progression regardless of achieved SBP goals (Table). In addition, substantial atheroma progression was still observed even if diabetic patients achieved SBP < 120mmHg.
Conclusions: The benefit of stricter SBP lowering strategy was observed in non-diabetics but not diabetics. Substantial progression in diabetics despite achieving lower SBP highlights the need to identify additional therapeutic target to modulate atherosclerosis in diabetics with coronary artery disease.
Author Disclosures: Y. Kataoka: None. A. Hsu: None. K. Wolski: None. K. Uno: None. R. Puri: None. E. Tuzcu: None. S.E. Nissen: Research Grant; Modest; Pfizer, AstraZeneca, Novartis, Roche, Daiichi-Sankyo, Takeda, Sanofi-Aventis, Resverlrogix, Eli lilly. S.J. Nicholls: Research Grant; Modest; Anthera, AstraZeneca, Cerenis, EliLilly, InfraReDx, Roche, Resverlogix, Novartis, Amgen, LipoScience. Speakers Bureau; Modest; AstraZeneca, Pfizer, Merck Schering-Plough, Takeda. Consultant/Advisory Board; Modest; AstraZeneca, Abbott, Atheronova, Esperion, Amgen, Novartis, Omthera, CSL Behring, Boehringer Ingelheim, Pfizer, Merck Schering-Plough, Takeda, Roche, NovoNordisk, LipoScience, Anthera.
- © 2014 by American Heart Association, Inc.