on October 13, 2009
Published online before print October 13, 2009, doi: 10.1161/CIRCINTERVENTIONS.109.876672
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Original Article |
Diabetes Duration Is Associated With Increased Thin-Cap Fibroatheroma Detected by Intravascular Ultrasound With Virtual Histology
From the Mid America Heart Institute, University of Missouri-Kansas City, Saint Luke's Hospital, Kansas City, Mo.
Correspondence to Steven P. Marso, MD, Mid America Heart Institute, Saint Luke's Hospital, University of Missouri Kansas City, 4401 Wornall Rd, Kansas City, MO 64111. E-mail smarso{at}saint-lukes.org
Background—Coronary plaque classified as thin-cap fibroatheroma (TCFA) is believed to be associated with plaque rupture and coronary heart disease-related events. Although an association between duration of diabetes and increased coronary heart disease risk has been demonstrated, the relationship between TCFA and diabetes duration is unknown.
Methods and Results—Prospective registry of diabetic patients undergoing diagnostic coronary angiography and intravascular ultrasound (IVUS) enrolled in a diabetic gene and biomarker banking registry. Plaque composition in the most diseased 10-mm segment of a single coronary artery was assessed using IVUS virtual histology and was classified by phenotype as IVUS-defined adaptive intimal thickening, pathological intimal thickening, TCFA, fibroatheroma, or fibrocalcific. Patients (n=54) were stratified by duration of diabetes (<10 or 
10 years). Patients with diabetes 10 years were older, less likely to have a history of tobacco use, had higher total cholesterol levels, and were more likely to be treated with insulin compared with patients with diabetes <10 years. Longer duration of diabetes was associated with greater plaque burden in the most diseased 10-mm segment (60.4% [53.4% to 66.8%] versus 50.2% [47.7% to 58.4%], P=0.008). The proportion of IVUS-defined TCFA in the 10-year group was greater than the <10-year group (54.4% [11.6% to 77.5%] versus 10.8% [0.0% to 26.1%], P=0.009). This association persisted after adjustment for multiple comparisons, clinical characteristics, and diabetes treatment.
Conclusions—In this cohort, longer duration of diabetes was associated with IVUS-defined TCFA, a plaque phenotype associated with risk of rupture and coronary heart disease events.
Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00428961.
Key Words: diabetes mellitus • atherosclerosis • imaging • plaque
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