Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA.
Biostatistics Center Massachusetts General Hospital Harvard Medical School Boston MA.
J Am Heart Assoc. 2023 Dec 5;12(23):e031474. doi: 10.1161/JAHA.123.031474. Epub 2023 Nov 28.
High cardiovascular mortality has been reported in young patients with diabetes. However, the underlying pathology in different age groups of patients with diabetes has not been studied.
The aim of this study was to investigate the plaque characteristics and underlying pathology of acute coronary syndrome in different age groups of patients with or without diabetes in a large cohort. Patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography imaging were included. Culprit plaque was classified as plaque rupture, plaque erosion, or calcified plaque and stratified into 5 age groups. Plaque characteristics including features of vulnerability were examined by optical coherence tomography. Among 1394 patients, 482 (34.6%) had diabetes. Patients with diabetes, compared with patients without diabetes, had a higher prevalence of lipid-rich plaque (71.2% versus 64.8%, =0.016), macrophage (72.0% versus 62.6%, <0.001), and cholesterol crystal (27.6% versus 19.7%, <0.001). Both diabetes and nondiabetes groups showed a decreasing trend in plaque erosion with age (patients with diabetes, =0.020; patients without diabetes, <0.001). Patients without diabetes showed an increasing trend with age in plaque rupture (=0.004) and lipid-rich plaque (=0.018), whereas patients with diabetes had a high prevalence of these vulnerable features at an early age that remained high across age groups.
Patients without diabetes showed an increasing trend with age in plaque rupture and lipid-rich plaque, whereas patients with diabetes had a high prevalence of these vulnerable features at an early age. These results suggest that atherosclerotic vascular changes with increased vulnerability start at a younger age in patients with diabetes.
URL: https://www.clinicaltrials.gov; Unique identifiers: NCT04523194, NCT03479723. URL: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000041692.
已有研究报道，年轻的糖尿病患者心血管死亡率较高。然而，不同年龄段糖尿病患者的潜在病理机制尚未得到研究。
本研究旨在通过大样本量研究，探讨不同年龄段伴或不伴糖尿病的急性冠脉综合征患者的斑块特征和潜在病理机制。纳入急性冠脉综合征且行术前光学相干断层扫描成像的患者。将罪犯斑块分为斑块破裂、斑块侵蚀或钙化斑块，并分为 5 个年龄组。通过光学相干断层扫描检查斑块特征，包括易损斑块特征。在 1394 例患者中，482 例（34.6%）患有糖尿病。与无糖尿病患者相比，糖尿病患者脂质丰富斑块（71.2%比 64.8%，=0.016）、巨噬细胞（72.0%比 62.6%，<0.001）和胆固醇结晶（27.6%比 19.7%，<0.001）的发生率更高。糖尿病和非糖尿病组斑块侵蚀均随年龄呈下降趋势（糖尿病患者，=0.020；非糖尿病患者，<0.001）。无糖尿病患者的斑块破裂（=0.004）和脂质丰富斑块（=0.018）发生率随年龄呈上升趋势，而糖尿病患者在年轻时就具有这些易损特征，且在各年龄段的发生率均较高。
无糖尿病患者的斑块破裂和脂质丰富斑块发生率随年龄增长呈上升趋势，而糖尿病患者在年轻时就具有这些易损特征。这些结果表明，糖尿病患者的动脉粥样硬化血管变化和易损性增加发生在更年轻的年龄。
