Association between blood glucose variability and coronary plaque instability in patients with acute coronary syndromes.
BACKGROUND
Blood glucose variability is receiving considerable attention as a new risk factor for coronary artery disease. This study aimed to investigate the association between blood glucose variability and coronary plaque tissue characteristics.


METHODS
In 57 patients with acute coronary syndrome, integrated backscatter intravascular ultrasound (IB-IVUS) and gray-scale IVUS were performed before balloon dilatation or stent implantation in the culprit vessels. Standard IVUS indices were evaluated for volume index (volume/length), and plaque components were measured by IB-IVUS for percent tissue volume. In addition to conventional glucose indicators, blood glucose variability in a stable state was determined by calculating the mean amplitude of glycemic excursions (MAGE) using a continuous glucose monitoring system.


RESULTS
Higher MAGE values were significantly correlated with larger percent plaque volumes (r = 0.32, p = 0.015), and increased lipid (r = 0.44, p = 0.0006) and decreased fibrous (r = -0.45, p = 0.0005) plaque components. In contrast, HbA1c or fasting plasma glucose values were not significantly correlated with plaque volumes and percent plaque components. Homeostasis model assessment of insulin resistance values were positively correlated with vessel (r = 0.35, p = 0.007) and plaque (r = 0.27, p = 0.046) volumes, but not with percent plaque components. In multiple regression analysis, higher MAGE values were independently associated with increased lipid (β = 0.80, p = 0.0035) and decreased fibrous (β = -0.79, p = 0.0034) contents in coronary plaques.


CONCLUSIONS
Among all glucose indicators studied, only higher blood glucose variability was an independent determinant of increased lipid and decreased fibrous contents with larger plaque burden, suggesting blood glucose variability as one of the important factors related to coronary plaque vulnerability.
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. kozookada@gmail.com.
Kozo
K
Okada
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. hibikiyo@yokohama-cu.ac.jp.
Kiyoshi
K
Hibi
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. gocchi3@hotmail.com.
Masaomi
M
Gohbara
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. skykks1118@yahoo.co.jp.
Shunsuke
S
Kataoka
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. kgossy@aol.com.
Keiko
K
Takano
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. e-akiyam@kumamoto-u.ac.jp.
Eiichi
E
Akiyama
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. matsu@yokohama-cu.ac.jp.
Yasushi
Y
Matsuzawa
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. kenichiros76@gmail.com.
Kenichiro
K
Saka
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. nmaejima@yokohama-cu.ac.jp.
Nobuhiko
N
Maejima
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. mitsuendy@yahoo.co.jp.
Mitsuaki
M
Endo
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. wsnorikun@yahoo.co.jp.
Noriaki
N
Iwahashi
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. k-tsuka@urahp.yokohama-cu.ac.jp.
Kengo
K
Tsukahara
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. masami.kosuge@gmail.com.
Masami
M
Kosuge
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. tebina@med.yokohama-cu.ac.jp.
Toshiaki
T
Ebina
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, USA. pfitz@stanford.edu.
Peter J
PJ
Fitzgerald
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, USA. honda@stanford.edu.
Yasuhiro
Y
Honda
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan. umemuras@med.yokohama-cu.ac.jp.
Satoshi
S
Umemura
Division of Cardiology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. c-kimura@urahp.yokohama-cu.ac.jp.
Kazuo
K
Kimura
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005355:Fibrosis; D006801:Humans; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D012720:Severity of Illness Index; D018084:Ultrasonography, Interventional; D015854:Up-Regulation
D015415:Biomarkers; D001786:Blood Glucose; D008055:Lipids