Nakanishi Rine, Ceponiene Indre, Osawa Kazuhiro, Luo Yanting, Kanisawa Mitsuru, Megowan Nichelle, Nezarat Negin, Rahmani Sina, Broersen Alexander, Kitslaar Pieter H, Dailing Christopher, Budoff Matthew J
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, 90502, USA.
Atherosclerosis. 2016 Dec;255:73-79. doi: 10.1016/j.atherosclerosis.2016.11.004. Epub 2016 Nov 3.
We aimed at investigating whether diabetes is associated with progression in coronary plaque components.
We identified 142 study subjects undergoing serial coronary computed tomography angiography. The resulting propensity score was applied 1:1 to match diabetic patients to non-diabetic patients for clinical risk factors, prior coronary stenting, coronary artery calcium (CAC) score and the serial scan interval, resulting in the 71 diabetes and 71 non-diabetes patients. Coronary plaque (total, calcified, non-calcified including fibrous, fibrous-fatty and low attenuation plaque [LAP]) volume normalized by total coronary artery length was measured using semi-automated plaque software and its change overtime between diabetic and non-diabetic patients was evaluated.
The matching was successful without significant differences between the two groups in all matched variables. The baseline volumes in each plaque also did not differ. During a mean scan interval of 3.4 ± 1.8 years, diabetic patients showed a 2-fold greater progression in normalized total plaque volume (TPV) than non-diabetes patients (52.8 mmvs. 118.3 mm, p = 0.005). Multivariable linear regression model revealed that diabetes was associated with normalized TPV progression (β 72.3, 95%CI 24.3-120.3). A similar trend was observed for the non-calcified components, but not calcified plaque (β 3.8, 95%CI -27.0-34.7). Higher baseline CAC score was found to be associated with total, non-calcified and calcified plaque progression. However, baseline non-calcified volume but not CAC score was associated with LAP progression.
The current study among matched patients indicates diabetes is associated with a greater plaque progression. Our results show the need for strict adherence of diabetic patients to the current preventive guidelines.
我们旨在研究糖尿病是否与冠状动脉斑块成分的进展相关。
我们确定了142名接受系列冠状动脉计算机断层扫描血管造影的研究对象。将得到的倾向评分按1:1应用于糖尿病患者与非糖尿病患者，使其在临床危险因素、既往冠状动脉支架置入术、冠状动脉钙化（CAC）评分及系列扫描间隔方面相匹配，最终得到71例糖尿病患者和71例非糖尿病患者。使用半自动斑块软件测量经冠状动脉总长度标准化的冠状动脉斑块（总斑块、钙化斑块、非钙化斑块，包括纤维斑块、纤维脂肪斑块和低密度斑块[LAP]）体积，并评估糖尿病患者和非糖尿病患者之间其随时间的变化。
匹配成功，两组在所有匹配变量上均无显著差异。各斑块的基线体积也无差异。在平均3.4±1.8年的扫描间隔期内，糖尿病患者经标准化的总斑块体积（TPV）进展比非糖尿病患者大2倍（52.8mm对118.3mm，p = 0.005）。多变量线性回归模型显示，糖尿病与经标准化的TPV进展相关（β 72.3，95%CI 24.3 - 120.3）。非钙化成分也观察到类似趋势，但钙化斑块未观察到（β 3.8，95%CI - 27.0 - 34.7）。发现较高的基线CAC评分与总斑块、非钙化斑块和钙化斑块进展相关。然而，与LAP进展相关的是基线非钙化体积而非CAC评分。
当前在匹配患者中的研究表明，糖尿病与更大的斑块进展相关。我们的结果表明糖尿病患者需要严格遵循当前的预防指南。
