Background: Intravascular ultrasound (IVUS) imaging represents the predominant approach for evaluating progression of coronary atherosclerosis (CA). IVUS provides a precise and reproducible method for determining changes in coronary atheroma burden. Previous studies have confirmed that low levels of LDL-cholesterol (LDL) are associated with a slower CA progression. However, the potential relationship between adequate control of HDL-cholesterol (HDL) and triglycerides (TG) and CA progression remains unknown.
Objective: We sought to investigate CA progression in relation to the extent of lipid control (LDL, HDL and TG) in diabetic patients.
Methods: One hundred nine diabetic patients (mean age 68±9 years, 34 [31%] female) undergoing serial IVUS studies were analyzed (media time interval 474 days). A validated system for volumetric IVUS analysis (EchoScan, TOMTEC) was used for off-line, three-dimensional reconstruction and volumetric analysis. Target lipid levels were those of current guidelines. Levels of LDL, HDL and TG were carefully monitored. Lumen and external elastic membrane volumes, normalized total atheroma volume (TAV) and percent atheroma volume (PAV) were calculated in the target segment in each patient, at baseline and at follow-up. CA progression was measured and defined as the change of TAV and PAV (ΔTAV and ΔPAV). The primary objective was to determine whether inadequate lipid control in diabetic patients is associated with increased CA progression.
Results: In our population of diabetic patients with a high prevalence of statin therapy (89%), inadequate control of the levels of LDL (LDL >70 mg/dl) was not associated with a greater CA progression. However, diabetic patients with inadequate control of both HDL and TG (HDL <40 mg/dl and TG >150 mg/dl) showed significantly most CA progression as measured by the ΔTAV (7,7±21,9 mm3 vs -3,8±19,3 mm3, p=0,006) and by the ΔPAV (1,2±4,9% vs -0,5±3,4%, p=0,034).
Conclusions: Diabetic dyslipidemia (low HDL and high triglycerides levels) is associated with increased CA progression. These findings suggest the need for intensive lipid control in diabetic patients with coronary artery disease, with especial emphasis to obtain adequate control of HDL and TG levels.