Impact of diabetes mellitus on coronary atherosclerosis and plaque composition under statin therapy – subanalysis of the TRUTH study –.
BACKGROUND
Patients with diabetes mellitus (DM) have a markedly increased incidence of adverse cardiovascular events, but the mechanisms have not been well-characterized.


RESULTS
The TRUTH study evaluated the effects of 8-month statin therapy on coronary artery plaque composition using virtual histology intravascular ultrasound (IVUS). Analyzable IVUS data were obtained from 119 patients, including 50 DM patients. The pattern of arterial remodeling, extent of coronary atherosclerosis, and plaque composition were compared in subjects with and without DM. Significant decreases in atheroma volume (-2.3%, P=0.02) and external elastic membrane volume (-1.7%, P=0.02) were observed only in the non-DM group. Although statin therapy significantly decreased the fibro-fatty component in both groups, this component at follow-up was significantly greater in the DM group (0.99 mm(3)/mm vs. 0.70 mm(3)/mm, P=0.03). Multivariate regression analysis showed that the presence of DM was associated with greater atheroma volume (β=0.203, P=0.02), particularly fibro-fatty plaque volume at follow-up (β=0.215, P=0.01).


CONCLUSIONS
DM attenuated the degree of regression of coronary atherosclerosis under statin therapy. A large amount of fibro-fatty plaque volume under statin therapy may affect the development of coronary events in patients with DM.
Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Yokohama, Japan. nozue2493@yahoo.co.jp
Tsuyoshi
T
Nozue
Shingo
S
Yamamoto
Shinichi
S
Tohyama
Kazuki
K
Fukui
Shigeo
S
Umezawa
Yuko
Y
Onishi
Tomoyuki
T
Kunishima
Akira
A
Sato
Toshihiro
T
Nozato
Shogo
S
Miyake
Youichi
Y
Takeyama
Yoshihiro
Y
Morino
Takao
T
Yamauchi
Toshiya
T
Muramatsu
Kiyoshi
K
Hibi
Mitsuyasu
M
Terashima
Ichiro
I
Michishita
D000368:Aged; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism; D048909:Diabetes Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000378:metabolism; D011446:Prospective Studies; D018084:Ultrasonography, Interventional
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors