South Australian Health & Medical Research Institute.
J Atheroscler Thromb. 2014;21(5):509-18. doi: 10.5551/jat.21089. Epub 2014 Jan 15.
In the DIANA(DIAbetes and diffuse coronary NArrowing) study, which evaluated the impact of glucose-lowering therapy in early-stage diabetics with coronary artery disease(CAD), optimal glycemic control resulted in reduced disease progression on angiography. However, despite having a favorable glycemic status, some patients continued to exhibit disease progression. Factors associated with disease progression despite optimal glucose control remain to be elucidated. We sought to investigate clinical characteristics associated with substantial atheroma progression in early-stage diabetic patients with CAD who achieve favorable glycemic control.
The DIANA study is a prospective randomized trial comparing the effects of lifestyle intervention and treatment with voglibose or nateglinide on disease progression on angiography in 302 CAD patients with impaired glucose tolerance/newly diagnosed diabetes. Of these patients, 137 CAD subjects who achieved optimal glycemic control were stratified according to the presence of disease progression on angiography: progressors(n=64) and non-progressors(n=73). Serial coronary angiography studies and quantitative coronary angiography analyses were conducted to evaluate disease progression. A multivariate analysis was performed to elucidate factors associated with disease progression.
Despite the achievement of optimal glycemic control, atheroma progression was observed in 46% of the study subjects. The progressors exhibited lower decreases in systolic blood pressure(SBP: p=0.007) and reduced baseline total lesion lengths(TLL: p=0.01). The multivariate analysis demonstrated that a greater increase in SBP(p=0.006), treatment without statins(p=0.03) and the baseline TLL(p=0.007) were independently associated with disease progression.
Residual risk factors contribute to the progression of coronary atherosclerosis in early-stage diabetics who exhibit improvements in their glycemic status. The present findings underscore the need to intensively modify multiple risk factors during the early diabetic phase in order to prevent atheroma progression.
在 DIANA（糖尿病和弥漫性冠状动脉狭窄）研究中，评估了降糖治疗对伴有冠状动脉疾病（CAD）的早期糖尿病患者的影响，结果显示，最佳血糖控制可减少血管造影上的疾病进展。然而，尽管血糖控制良好，一些患者仍继续出现疾病进展。与最佳血糖控制下疾病进展相关的因素仍有待阐明。我们试图研究在达到良好血糖控制的 CAD 合并早期糖尿病患者中，与动脉粥样硬化实质性进展相关的临床特征。
DIANA 研究是一项前瞻性随机试验，比较了生活方式干预和 voglibose 或 nateglinide 治疗对 302 例糖耐量受损/新诊断糖尿病合并 CAD 患者血管造影疾病进展的影响。在这些患者中，根据血管造影上疾病进展情况，将 137 例达到最佳血糖控制的 CAD 患者分为进展组（n=64）和非进展组（n=73）。进行了连续冠状动脉造影研究和定量冠状动脉造影分析，以评估疾病进展。进行了多变量分析以阐明与疾病进展相关的因素。
尽管达到了最佳血糖控制，但仍有 46%的研究对象出现动脉粥样硬化进展。进展组的收缩压（SBP）下降幅度较小（p=0.007），基线总病变长度（TLL）较短（p=0.01）。多变量分析显示，SBP 升高幅度较大（p=0.006）、未接受他汀类药物治疗（p=0.03）和基线 TLL 较大（p=0.007）与疾病进展独立相关。
残留的危险因素导致血糖状态改善的早期糖尿病患者的冠状动脉粥样硬化进展。这些发现强调了在糖尿病早期阶段需要积极强化多种危险因素的治疗，以预防动脉粥样硬化进展。
