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RECENT PUBLICATIONS ON RESIDUAL RISK

2017

Plaque profile in diabetes

According to this study, individuals with diabetes mellitus have a more advanced arterial plaque phenotype than those without diabetes, and these differences continue to progress despite similar low-density lipoprotein cholesterol (LDL-C) control. These differences may, at least partly, explain the higher cardiovascular morbidity and mortality in diabetic individuals.
 
The authors evaluated changes in plaque volume and plaque phenotype during lipid-lowering therapy in 61 patients with stable angina pectoris (17 with diabetes mellitus) included in the PREDICT trial (ClinicalTrials.gov identifier NCT01773512). Only those patients with intravascular ultrasound-virtual histology (IVUS-VH) of a native coronary artery with ?50% lumen stenosis at baseline; imaged vessels free of severe calcification; and with sufficient quality baseline and follow-up data were evaluated. At baseline, 14 (82%) diabetic patients and 34 (77%) non-diabetic patients were on a statin; mean LDL-C levels were comparable (2.42 and 2.46 mmol/L).
 
Despite attaining similar LDL-C levels, diabetic patients had evidence of greater progression of plaque area (0.47 ± 1.15 mm2 vs. 0.21 ± 0.97 mm2 in patients without diabetes, p = 0.001) and percent atheroma volume (0.7 ± 2.8% vs. ? 1.4 ± 2.5%, p = 0.007), and had more locations with thin-cap fibro-atheroma plaque phenotype (20.3% vs. 12.5%, p = 0.01). These findings imply that currently-achieved LDL-C lowering is insufficient for stabilizing atherosclerotic plaque in diabetes patients, and that other lipid and non-lipid parameters should be considered.
Plaque volume and plaque risk profile in diabetic vs. non?diabetic patients undergoing lipid?lowering therapy: a study based on 3D intravascular ultrasound and virtual histology.

Kovarnik T, Chen Z, Mintz GS et al.