title: Association between daily glucose fluctuation and coronary plaque properties in patients receiving adequate lipid-lowering therapy assessed by continuous glucose monitoring and optical coherence tomography.
abstract: BACKGROUND
  Glucose fluctuation has been recognized as a residual risk apart from dyslipidemia for the development of coronary artery disease (CAD). This study aimed to investigate the association between glucose fluctuation and coronary plaque morphology in CAD patients.
  
  
  METHODS
  This prospective study enrolled 72 consecutive CAD patients receiving adequate lipid-lowering therapy. They were divided into 3 tertiles according to the mean amplitude of glycemic excursions (MAGE), which represents glucose fluctuation, measured by continuous glucose monitoring (tertile 1; < 49.1, tertile 2; 49.1 ~ 85.3, tertile 3; >85.3). Morphological feature of plaques were evaluated by optical coherence tomography. Lipid index (LI) (mean lipid arc × length), fibrous cap thickness (FCT), and the prevalence of thin-cap fibroatheroma (TCFA) were assessed in both culprit and non-culprit lesions.
  
  
  RESULTS
  In total, 166 lesions were evaluated. LI was stepwisely increased according to the tertile of MAGE (1958 ± 974 [tertile 1] vs. 2653 ± 1400 [tertile 2] vs. 4362 ± 1858 [tertile 3], p < 0.001), whereas FCT was the thinnest in the tertile 3 (157.3 ± 73.0 μm vs. 104.0 ± 64.1 μm vs. 83.1 ± 34.7 μm, p < 0.001, respectively). The tertile 3 had the highest prevalence of TCFA. Multiple linear regression analysis showed that MAGE had the strongest effect on LI and FCT (standardized coefficient β = 0.527 and -0.392, respectively, both P < 0.001). Multiple logistic analysis identified MAGE as the only independent predictor of the presence of TCFA (odds ratio 1.034; P < 0.001).
  
  
  CONCLUSIONS
  Glucose fluctuation and hypoglycemia may impact the formation of lipid-rich plaques and thinning of fibrous cap in CAD patients with lipid-lowering therapy.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. kuroro19800115@hotmail.com.
authors.forename: Masaru
authors.initials: M
authors.lastname: Kuroda
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. shinke@med.kobe-u.ac.jp.
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.affiliation: Division of Diabetes and Metabolism, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. kzhkskgc@med.kobe-u.ac.jp.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Sakaguchi
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. hotake@med.kobe-u.ac.jp.
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. toto54@hotmail.com.
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Takaya
authors.affiliation: Division of Diabetes and Metabolism, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. hirota@med.kobe-u.ac.jp.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Hirota
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. t.ohsue@gmail.com.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Osue
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. hkinutani@hotmail.com.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kinutani
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. akihide-koni@live.jp.
authors.forename: Akihide
authors.initials: A
authors.lastname: Konishi
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. hachi_8_xyz_8@hotmail.co.jp.
authors.forename: Hachidai
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. saibaidike@yahoo.co.jp.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Terashita
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. kenzouduu@hotmail.com.
authors.forename: Kenzo
authors.initials: K
authors.lastname: Uzu
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. hiratak@med.kobe-u.ac.jp.
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Hirata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism*; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D050171:Dyslipidemias / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D007003:Hypoglycemia / Q000150:complications / Q000453:epidemiology / Q000378:metabolism*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D041623:Tomography, Optical Coherence
chemical_list: D001786:Blood Glucose; D000960:Hypolipidemic Agents