Coronary Plaque Characteristics and Underlying Mechanism of Acute Coronary Syndromes in Different Age Groups of Patients With Diabetes

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.

Keywords: acute coronary syndrome; age; diabetes; optical coherence tomography.

Figure 1. Plaque phenotype among different age groups in patients with and without diabetes.

Both patients with and without diabetes showed a decreasing trend in plaque erosion and increasing trend in calcified plaque with age. Patients without diabetes showed an increasing trend with age in plaque rupture, whereas patients with diabetes had a high prevalence of plaque rupture at an early age, which plateaued across age groups. P values are for the Cochran–Armitage trend test for categorical data. CP indicates calcified plaque; PE, plaque erosion; and PR, plaque rupture.

Figure 2. The prevalence of lipid‐rich plaque in different age groups.

Patients without diabetes showed an increasing trend with age in lipid‐rich plaque, whereas patients with diabetes had a high prevalence of lipid‐rich plaque at an early age, which plateaued across age groups. P values are for the Cochran–Armitage trend test for the prevalence of lipid‐rich plaque.

Figure 3. Age and plaque characteristics in patients with and without diabetes.

Patients without diabetes had 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 that plateaued across age groups. Both patients with and without diabetes showed a decreasing trend in plaque erosion with age.