Affiliation:
1. Cardiology Division Massachusetts General Hospital Harvard Medical School Boston MA
2. Biostatistics Center Massachusetts General Hospital Harvard Medical School Boston MA
3. Cardiovascular Center Nippon Medical School Chiba Hokusoh Hospital Inzai, Chiba Japan
4. Interventional Cardiology Unit New Tokyo Hospital Chiba Japan
5. Department of Cardiology Tsuchiura Kyodo General Hospital, Tsuchiura Ibaraki Japan
6. Mitsukoshi Health and Welfare Foundation Tokyo Japan
Abstract
Background
High cardiovascular mortality has been reported in young patients with diabetes. However, the underlying pathology in different age groups of patients with diabetes has not been studied.
Methods and Results
The aim of this study was to investigate the plaque characteristics and underlying pathology of acute coronary syndrome in different age groups of patients with or without diabetes in a large cohort. Patients who presented with acute coronary syndrome and underwent preintervention optical coherence tomography imaging were included. Culprit plaque was classified as plaque rupture, plaque erosion, or calcified plaque and stratified into 5 age groups. Plaque characteristics including features of vulnerability were examined by optical coherence tomography. Among 1394 patients, 482 (34.6%) had diabetes. Patients with diabetes, compared with patients without diabetes, had a higher prevalence of lipid‐rich plaque (71.2% versus 64.8%,
P
=0.016), macrophage (72.0% versus 62.6%,
P
<0.001), and cholesterol crystal (27.6% versus 19.7%,
P
<0.001). Both diabetes and nondiabetes groups showed a decreasing trend in plaque erosion with age (patients with diabetes,
P
=0.020; patients without diabetes,
P
<0.001). Patients without diabetes showed an increasing trend with age in plaque rupture (
P
=0.004) and lipid‐rich plaque (
P
=0.018), whereas patients with diabetes had a high prevalence of these vulnerable features at an early age that remained high across age groups.
Conclusions
Patients without diabetes showed an increasing trend with age in plaque rupture and lipid‐rich plaque, whereas patients with diabetes had a high prevalence of these vulnerable features at an early age. These results suggest that atherosclerotic vascular changes with increased vulnerability start at a younger age in patients with diabetes.
Registration
URL:
https://www.clinicaltrials.gov
; Unique identifiers: NCT04523194, NCT03479723. URL:
https://www.umin.ac.jp/ctr/
. Unique identifier: UMIN000041692.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine