Impact of Diabetes Mellitus on Coronary Atherosclerosis and Plaque Composition Under Statin Therapy – Subanalysis of the TRUTH Study –

Tsuyoshi Nozue; Shingo Yamamoto; Shinichi Tohyama; Kazuki Fukui; Shigeo Umezawa; Yuko Onishi; Tomoyuki Kunishima; Akira Sato; Toshihiro Nozato; Shogo Miyake; Youichi Takeyama; Yoshihiro Morino; Takao Yamauchi; Toshiya Muramatsu; Kiyoshi Hibi; Mitsuyasu Terashima; Ichiro Michishita; for the TRUTH Investigators

doi:10.1253/circj.CJ-11-1303

Ischemic Heart Disease

Impact of Diabetes Mellitus on Coronary Atherosclerosis and Plaque Composition Under Statin Therapy

– Subanalysis of the TRUTH Study –

Tsuyoshi Nozue, Shingo Yamamoto, Shinichi Tohyama, Kazuki Fukui, Shigeo Umezawa, Yuko Onishi, Tomoyuki Kunishima, Akira Sato, Toshihiro Nozato, Shogo Miyake, Youichi Takeyama, Yoshihiro Morino, Takao Yamauchi, Toshiya Muramatsu, Kiyoshi Hibi, Mitsuyasu Terashima, Ichiro Michishita, for the TRUTH Investigators

Author information

Tsuyoshi Nozue
Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital
Shingo Yamamoto
Department of Cardiology, Tsurumi Nishiguchi Hospital
Shinichi Tohyama
Department of Cardiology, Yokohama Seamen’s Insurance Hospital
Kazuki Fukui
Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
Shigeo Umezawa
Department of Cardiology, Hiratsuka Kyosai Hospital
Yuko Onishi
Department of Cardiology, Hiratsuka Kyosai Hospital
Tomoyuki Kunishima
Fourth Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
Akira Sato
Cardiovascular Center, Yokosuka Kyosai Hospital
Toshihiro Nozato
Department of Cardiology, National Hospital Organization, Disaster Medical Center
Shogo Miyake
Department of Cardiology, Ebina General Hospital
Youichi Takeyama
Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital
Yoshihiro Morino
Department of Cardiology, Tokai University School of Medicine
Takao Yamauchi
Department of Cardiology, Tokyo Women’s Medical University
Toshiya Muramatsu
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
Kiyoshi Hibi
Division of Cardiology, Yokohama City University Medical Center
Mitsuyasu Terashima
Cardiovascular Imaging Center
Ichiro Michishita
Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital
for the TRUTH Investigators

Keywords: Coronary atherosclerosis, Diabetes mellitus, Plaque composition, Statin, Virtual histology intravascular ultrasound

JOURNAL FREE ACCESS

2012 Volume 76 Issue 9 Pages 2188-2196

DOI https://doi.org/10.1253/circj.CJ-11-1303

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Abstract

Background: Patients with diabetes mellitus (DM) have a markedly increased incidence of adverse cardiovascular events, but the mechanisms have not been well-characterized. Methods and Results: The TRUTH study evaluated the effects of 8-month statin therapy on coronary artery plaque composition using virtual histology intravascular ultrasound (IVUS). Analyzable IVUS data were obtained from 119 patients, including 50 DM patients. The pattern of arterial remodeling, extent of coronary atherosclerosis, and plaque composition were compared in subjects with and without DM. Significant decreases in atheroma volume (–2.3%, P=0.02) and external elastic membrane volume (–1.7%, P=0.02) were observed only in the non-DM group. Although statin therapy significantly decreased the fibro-fatty component in both groups, this component at follow-up was significantly greater in the DM group (0.99mm³/mm vs. 0.70mm³/mm, P=0.03). Multivariate regression analysis showed that the presence of DM was associated with greater atheroma volume (β=0.203, P=0.02), particularly fibro-fatty plaque volume at follow-up (β=0.215, P=0.01). Conclusions: DM attenuated the degree of regression of coronary atherosclerosis under statin therapy. A large amount of fibro-fatty plaque volume under statin therapy may affect the development of coronary events in patients with DM. (Circ J 2012; 76: 2188–2196)

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