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

BackgroundGlucose 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.MethodsThis 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.ResultsIn 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).ConclusionsGlucose fluctuation and hypoglycemia may impact the formation of lipid-rich plaques and thinning of fibrous cap in CAD patients with lipid-lowering therapy.

The fluctuation in sympathetic nerve activity around wake-up time was positively associated with not only morning but also daily glycemic variability in subjects with type 2 diabetes

“…Therefore, a drastic alteration in ANA around wake-up would be associated with glucose metabolism and glycemic variability (GV). Recent studies have reported that not only chronic hyperglycemia but daily GV is an independent risk factor for cardiovascular events [12,13]. To our knowledge, no study focusing on the association of the fluctuation in ANA around wake-up on GV has been reported.…”

Stabilization of high-risk plaques

“…The study population consisted of 85% patients with glucose metabolism disorder. In this study, MAGE was the only independent predictor of the presence of TCFA (124). Thus, it may be important to consider MAGE in the treatment of DM by using diabetic agents, such as α-GIs, TZDs, metformin, and incretins, which do not induce hypoglycemia except when administered in combination with sulfonylureas and insulin.…”

Plaque Characteristics in Coronary Artery Disease Patients with Impaired Glucose Tolerance

“…Kurihara et al demonstrated that coronary atherosclerosis and plaque vulnerability assessed using angioscopy were more advanced in prediabetic patients than in nondiabetic patients[25]. A recent study showed that glucose fluctuations impact not only atherosclerosis, but also the formation of lipid-rich plaques and thinning of the fibrous cap in CAD patients [26]. In the present study, we performed 75g OGTT in all the patients who had not been diagnosed as DM to specify the patients with IGT and demonstrated that plaque vulnerability was more advanced in CAD patients with IGT than those with NGT using OCT.…”