scholarly journals Effect of diabetes mellitus on coronary plaque characteristics and progression by serial Coronary Computed Tomography Angiography (CCTA)

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Lakshmanan ◽  
A Kinninger ◽  
R Nakanishi ◽  
C Shekar ◽  
K Shaikh ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Plaque ◽  
Vulnerable Population ◽  
Plaque Burden ◽  
Plaque Progression ◽  
Cardiac Events ◽  
Fibrous Plaque ◽  
Funding Sources ◽  
Increased Risk ◽  
Poor Outcomes

Abstract Background Diabetes Mellitus (DM) is a major risk factor for coronary artery disease (CAD) and associated poor outcomes. There is a higher incidence of major adverse cardiac events in patients with DM than those without DM. Coronary plaque characteristics measured by CCTA are correlated with adverse cardiovascular (CV) outcomes. Purpose We sought to evaluate coronary plaque characteristics as well as rates of progression of coronary plaque burden as measured by serial CCTA in patients with DM and those without DM. Methods The study population included a total of 403 participants (mean age 61.4±11.4 years, 53% men; median scan interval 1.5 years) who were prospectively enrolled in serial CCTA trials. We identified 212 participants with DM and 191 participants without DM, who had undergone serial CCTA. Coronary Plaque volumes were measured and characterized as low attenuation plaque (LAP), total non-calcified plaque (TNCP) and total plaque (TP) using semi-automated plaque analysis software (Qangio medis). Multivariate linear regression was used to examine the effect of DM on coronary plaque progression. Results Patients with DM had greater rates of progression of normalized TP volume (median change in annualized plaque (IQR): 39.1 (9.9–114.4) in DM vs 23.5 (4.1–63.8) mm3 in non-DM, p=0.001), TNCP volume (21.6 (3.3–60.8) in DM vs 8.7 (0.1–35.6) mm3 in non-DM, p=0.003) and LAP volumes (0.7 (−0.6 to 7.8) in DM vs 0.1 (−0.4 to 1.9) mm3 in non-DM, p=0.04). After adjusting for relevant risk factors and baseline plaque, the annualized rates of progression were higher in patients with DM by 28% for TP (p=0.004), 27% for TNCP (p=0.011), 23% for fibrous plaque (p=0.026) and by 42% LAP (p=0.050), compared to those without DM. Conclusion Patients with DM have significantly higher rates of coronary plaque progression, including vulnerable LAP, than those without DM. Our findings reveal differences in rates, burden and characteristics of coronary plaque progression in patients with DM vs those without DM. These results provide mechanistic understanding of natural history of coronary atherosclerosis in this vulnerable population, that could explain the increased risk of CV events among patients with DM. Coronary atherosclerotic phenotyping by CCTA could serve as a potential surrogate measure for risk stratification and evaluation in clinical trials to examine therapeutic strategies in this vulnerable population. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 15473: Effect of Statins on Coronary Plaque Progression Assessed by Serial Coronary Computed Tomography Angiography

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Suraj Dahal ◽  
Suvasini Lakshmanan ◽  
Khadije Ahmad ◽  
Vahid Rezvanizadeh ◽  
Ahmed K Ghanem ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Statin Therapy ◽  
Computed Tomography Angiography ◽  
Coronary Plaque ◽  
Analysis Of Covariance ◽  
Plaque Burden ◽  
Plaque Morphology ◽  
Plaque Progression ◽  
Fibrous Plaque ◽  
Calcified Plaque

Introduction: Statins stabilize coronary plaques and reduce clinical events. However, it is unclear how statins change the total plaque burden and plaque morphology. Hypothesis: We aimed at investigating whether statin users have less coronary plaque progression compared to non-statins users. Methods: We identified 243 subjects undergoing serial computed tomography angiography, 163 taking statins and 80 who are not. Coronary plaque (total, calcified, non-calcified including fibrous, fibrous-fatty and low-attenuation plaque (LAP)) volume was measured using semi-automated plaque software (Qangio, Medis) and its change overtime between statins users and non-statins users was evaluated using Analysis of Covariance (ANCOVA) modeling adjusted for age, gender, diabetic status, presence of hypertension, past smoking use, and baseline plaque levels. Results: Subjects on statin therapy had higher body mass index, were more likely to be diabetic, had hyperlipidemia, and were past smokers. Median coronary artery calcium score was significantly lower in the statin group; p<0.034. Driven primarily by changes in fibrous plaque, those on statin therapy showed 25% less total plaque (P=0.013) and 31% less total non-calcified plaque (P=0.006) at follow-up than non-statin users. Conclusions: The current study indicates that statin use is associated with less progression of total plaque and total non-calcified plaque burden.

Abstract 15270: Coronary Plaque Natural History Displays Marked Longitudinal Heterogeneity Along the Length of Individual Coronary Plaques

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jolanda J Wentzel ◽  
Michail I Papafaklis ◽  
Antonios Antoniadis ◽  
Saeko Takahashi ◽  
Nicholas V Cefalo ◽  
...  
Keyword(s):  
Shear Stress ◽  
Natural History ◽  
Coronary Arteries ◽  
Mixed Model ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Plaque Progression ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Maximal Wall Thickness

Introduction: Plaque natural history is related to local shear stress, and shear stress has been shown to be heterogeneously distributed along the length of individual plaques. We investigated the longitudinal spatial heterogeneity of plaque progression/regression/quiescence in human coronary arteries. Methods: 591 coronary arteries from 302 patients with coronary disease who presented with an acute coronary syndrome from the PREDICTION study were investigated for local plaque progression/regression/quiescence patterns in non-culprit plaques after 6-10 month FU. Arterial geometry was derived from angiography/IVUS-based vascular profiling and reported in 3 mm segments. Plaques were defined as >3 consecutive segments with maximal wall thickness>0.5 mm. Plaque progression was defined as >5% increase, regression as <-5% decrease, and quiescence as no change in plaque burden (plaque area/ total vessel area * 100%). Results: 5658 3mm-segments of 661 plaques were analyzed. Plaque burden changes ranged from -22% to +20%. Among all plaques, 56% showed segments with plaque progression, 60% with regression and 96% with quiescence. On average, 17% of the plaque length displayed plaque progression, 20% regression and 63% quiescence. The presence and number of natural history features (progression, regression, quiescence) within the individual plaques were significantly related to plaque length using logistic mixed model regression analysis (figure). Conclusions: Coronary plaque natural history is extremely heterogeneous along the length of an individual plaque. These observations may explain why revascularization of a focal severe obstruction in the ISCHEMIA trial did not affect clinical outcomes, since remaining high-risk plaque up- or down-stream from the revascularization may have led to future cardiac events.

Abstract P193: Increased High Density Lipoprotein Cholesterol:ApolipoproteinA1 Ratio is Associated with Less Progression of Coronary Atherosclerosis in Statin-Treated Patients

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Preethi Mani ◽  
Kiyoko Uno ◽  
Julie Thornton ◽  
Stephen Nicholls
Keyword(s):  
Coronary Atherosclerosis ◽  
Coronary Plaque ◽  
Cholesterol Content ◽  
Favorable Effect ◽  
Plaque Burden ◽  
P Value ◽  
Plaque Progression ◽  
Coronary Syndrome ◽  
Hdl Function ◽  
Atheroma Volume

Background HDL cholesterol (HDL-C) and apolipoprotein AI (apoAI) levels are inversely related to adverse cardiovascular outcome. Associations between these HDL related measures and their ratio with coronary plaque progression have not been studied. It has been proposed that increasing HDL particle cholesterol content impairs HDL function, but impact on disease progression is unknown. We hypothesize that all HDL related measures are inversely associated with coronary plaque progression. Methods Retrospective analysis was performed of 1528 statin treated patients with angiographic CAD who had serial evaluation of atheroma burden with intravascular ultrasound. Relationships between achieved levels of HDL related measures with clinical characteristics and changes in plaque burden were determined. Results Strong correlation between HDL-C and apoAI (r=0.73, p<0.0001) was noted. Patients with highest levels of HDL-C:apoAI were more likely to be female, black, and have lower BMI and less likely to be smokers or have previous revascularization (all p<0.001) or acute coronary syndrome (p=0.013). HDL-C, apoAI, and HDL-C:apoAI demonstrated negative correlation with change in total atheroma volume (p<0.01). For HDL-C:apoAI and HDL-C, increasing tertiles of achieved levels were associated with a linear benefit in slowing progression. For apoAI, a nonlinear association was seen, with similar benefit on progression in the middle and upper tertiles ( Table ). There was no statistical interaction for heterogeneity between HDL-C:apoAI and atheroma burden based on achieved levels of HDL-C (p=0.581). Change in IVUS Measures By Tertiles of Achieved HDL-related Parameters Percent Atheroma Volume Parameter T1 T2 T3 P Value HDL-C 0.58±0.27 0.26±0.27 0.11±0.27 0.012 ApoAI 0.28±0.26 −0.04±0.26 −0.08±0.26 0.10 HDL-C:ApoAI 0.22±0.27 0.13±0.27 −0.27±0.27 0.021 Total Atheroma Volume Parameter T1 T2 T3 P Value HDL-C −2.46±2.21 −4.18±2.20 −5.31±2.20 0.035 ApoAI −4.94±2.13 −6.30±2.13 −7.40±2.13 0.135 HDL-C:ApoAI −4.59±2.25 −6.38±2.24 −8.07±2.26 0.022 Conclusions Increase in all HDL related measures was associated with less progression of coronary atherosclerosis. Association of higher HDL-C:ApoAI with favorable effect on plaque progression at all levels of HDL-C suggests intact HDL functionality of larger cholesterol rich particles. Interventions that increase HDL particle cholesterol content, such as CETP inhibitors, may thus have beneficial effect at the artery wall.

Evaluation of human coronary vasodilator function predicts future coronary atheroma progression

Heart ◽  
2018 ◽  
Vol 104 (17) ◽  
pp. 1439-1446 ◽  
Author(s):  
Samuel L Sidharta ◽  
Timothy J Baillie ◽  
Stuart Howell ◽  
Stephen J Nicholls ◽  
Natalie Montarello ◽  
...  
Keyword(s):  
Near Infrared ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Plaque Progression ◽  
Independent Function ◽  
Lipid Core ◽  
Coronary Syndrome ◽  
Coronary Vasodilator ◽  
Dependent Function ◽  
The Relationship

ObjectiveCoronary vasodilator function and atherosclerotic plaque progression have both been shown to be associated with adverse cardiovascular events. However, the relationship between these factors and the lipid burden of coronary plaque remains unknown. These experiments focus on investigating the relationship between impaired coronary vasodilator function (endothelium dependent (salbutamol) and endothelium independent (glyceryl trinitrate)) and the natural history of atheroma plaque progression and lipid burden using dual modality intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS) imaging.Methods33 patients with stable chest pain or acute coronary syndrome underwent serial assessment of coronary vasodilator function and intracoronary plaque IVUS and NIRS imaging. Coronary segmental macrovascular response (% change segmental lumen volume (ΔSLV)), plaque burden (per cent atheroma volume (PAV)), lipid core (lipid-rich plaque (LRP) and lipid core burden index (LCBI)) were measured at baseline and after an interval of 12–18 months (n=520 segments).ResultsLipid-negative coronary segments which develop into LRP over the study time period demonstrated impaired endothelial-dependent function (−0.24±2.96 vs 5.60±1.47%, P=0.04) and endothelial-independent function (13.91±4.45 vs 21.19±3.19%, P=0.036), at baseline. By multivariate analysis, endothelial-dependent function predicted ∆LCBI (β coefficient: −3.03, 95% CI (−5.81 to −0.25), P=0.033) whereas endothelial-independent function predicted ∆PAV (β coefficient: 0.07, 95% CI (0.04 to 0.10), P<0.0001).ConclusionsEpicardial coronary vasodilator function is a determinant of future atheroma progression and composition irrespective of the nature of clinical presentation.Trial registration numberACTRN12612000594820, Post-results.

scholarly journals 0721 Coronary Atherosclerotic Plaque Burden and Composition in Patients with Obstructive Sleep Apnea by Coronary CT Angiography

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A274-A274
Author(s):  
M Lu ◽  
Y Wei ◽  
Z Wang ◽  
F Fang ◽  
S E John ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Linear Regression Analysis ◽  
Coronary Plaque ◽  
Plaque Burden ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Calcified Plaque

Abstract Introduction OSA is closely associated with increased risk of coronary artery disease. Although previous small studies have investigated coronary plaque in OSA patients, limited data are available regarding the association of OSA with plaque morphology and composition. Therefore, we aimed to quantitatively characterize and compare coronary plaque burden and composition between patients with no or mild obstructive sleep apnea (OSA) and moderate-severe OSA using coronary computed tomography angiography (CTA) in a large-scale study. Methods We retrospectively analyzed consecutive patients who underwent sleep monitoring and coronary CTA. Metrics reflecting coronary plaque characteristics were compared between patients with no or mild OSA with apnea hypoxic index (AHI) ≤15 and moderate-severe OSA (AHI&gt;15). The associations of OSA with coronary plaque components were determined by logistic and linear regression analysis. Results A total of 854 patients were enrolled in the study. Of these, 162 did not meet the inclusion criteria and of the remaining 692 patients 400 (57.8%) had moderate-severe OSA and 292 had no or mild OSA. Patients with moderate-severe OSA had a significantly higher total plaque volume, total non-calcified plaque (NCP) volume and total low density non-calcified plaque (LD-NCP) volume, and corresponding burden than those with no or mild OSA (all with p&lt;0.05). Multivariate logistic regression analysis revealed that moderate-severe OSA patients are more likely to have any plaque, NCP and LD-NCP than those without no or mild OSA (p&lt;0.05). In addition, stepwise multivariate linear regression analysis further revealed an independent relationship between moderate OSA (15&lt;AHI≤30) and more so between severe OSA (AHI&gt;30) and, NCP volume, LD-NCP volume, NCP composition, and LD-NCP composition, following adjustment for traditional cardiovascular risk factors, compared to no or mild OSA (AHI&lt;15) (all with a p&lt;0.05). Moderate-severe OSA conferred a similar odds ratio for LD-NCPs (a high-risk plaque) as the usual cardiovascular risk factors. Conclusion In this large cross-sectional study, OSA severity was associated with high-risk plaque features independent of traditional cardiovascular risk factors, suggesting an increased risk for cardiovascular events. Support This study was supported by NSFC (Project 81870335), International Science & Technology Cooperation Program of China (No.2015DFA30160), Beijing Municipal Science & Technology Commission (No. Z141100006014057)

scholarly journals Association of Food Pharmacy Participation with Type II Diabetes Mellitus Risk Factors

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 292-292
Author(s):  
Breanne Vinogradoff ◽  
Giselle Pereira Pignotti ◽  
Marcelle Dougan ◽  
John Gieng
Keyword(s):  
Diabetes Mellitus ◽  
Fasting Blood Glucose ◽  
Participation Rate ◽  
Safety Net ◽  
Type Ii Diabetes Mellitus ◽  
Clinical Markers ◽  
Funding Sources ◽  
Increased Risk ◽  
High Participation ◽  
Diabetes Mellitus Risk

Abstract Objectives Food insecurity poses a public health threat in a number of concerning ways, including increased risk of Type 2 Diabetes Mellitus (T2DM). A number of safety-net resource sites in the US are working to address this complex relationship through the disbursal of medically tailored food to clients with T2DM, sometimes referred to as a “food pharmacy”. Our study aimed to determine if participation by food insecure individuals in a food pharmacy affected clinical markers of T2DM status or risk, namely glycated hemoglobin (HbA1c), fasting blood glucose (FBG), or body mass index (BMI). Methods We conducted a retrospective study of data from a food pharmacy run by a safety-net healthcare clinic in California. Data from January 2016 through May 2019 were analyzed. Patients with T2DM were referred to the food pharmacy by clinic physicians. After referral, patients could pick up boxes of diabetes appropriate food (contents were determined by program staff and varied based on food availability) once a week. Results from participant's successive biomedical tests were recorded by clinic staff. Participants with a baseline measurement of HbA1c, FBG, or BMI within ±11 days of food pharmacy referral and at least one subsequent measurement of the same variable qualified for inclusion (n = 161). Participation rate was defined as the proportion of food pickup opportunities attended by each individual. Spearman correlation analysis, t-tests, and analyses of variance were conducted to determine the association between program participation on HbA1c, FBG, and BMI. Results At 24 months, increased food pharmacy participation correlated with a reduction in BMI (r = –0.39, P = 0.03, n = 29). As compared with those who participated below the median rate, the “high participation” group had a lower mean BMI at 24 months (34.6 ± 9.1 vs 29.1 ± 4.9 kg/m2, P = 0.05). Mean HbA1c was lower at 18 months as compared to baseline (9.1 ± 2.3 vs 8.2 ± 1.8%, P = 0.04). However, HbA1c and FBG were not correlated with participation rate. Conclusions This study found higher food pharmacy participation rates are associated with reductions in BMI, but not HbA1c or FBG. Food pharmacies may need to reevaluate their treatment model if they are to effectively target T2DM in food insecure individuals. Funding Sources None.

scholarly journals Impact of the UK COVID-19 pandemic on HbA1c testing and its implications for diabetes diagnosis and management

2020 ◽  
Author(s):  
David Holland ◽  
Adrian Heald ◽  
Mike Stedman ◽  
Lewis Green ◽  
Jonathan Scargill ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Diabetes Diagnosis ◽  
Long Term Conditions ◽  
Diagnosis And Management ◽  
Increased Risk ◽  
Poor Outcomes ◽  
The Uk ◽  
The Impact

Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for diabetes mellitus (DM). Ironically, failure to focus of the wider implications for people with DM and other groups with long-term conditions, may place them at increased risk of poor outcomes from SARS-CoV-2 infection itself, irrespective of the implications for their longer-term health prospects.

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