Vessel Shrinkage as a Sign of Atherosclerosis Progression in Type 2 Diabetes : A Serial Intravascular Ultrasound Analysis

OBJECTIVE—The aim of this study was to determine the natural history of vascular remodeling of atherosclerotic plaques in patients with type 2 diabetes and the predictors of vessel shrinkage. RESEARCH DESIGN AND METHODS—In this serial intracoronary ultrasound (IVUS) study, 237 coronary segments from 45 patients enrolled in the DIABETES I, II, and III trials were included. Quantitative volumetric IVUS analyses (motorized pullbacks at 0.5 mm/s) were performed in the same coronary segment after the index procedure and at the 9-month follow-up. Nontreated mild lesions (angiographic stenosis <25%) with ≥0.5 mm plaque thickening and length of ≥5 mm assessed by IVUS were included. Vessel shrinkage was defined as a Δexternal elastic membrane area/Δplaque area < 0. Statistical adjustment by multiple segments and multiple lesions per patient was performed. RESULTS—Vessel shrinkage was identified in 37.1% of segments and was associated with a significant decrease in lumen area at 9 months (vessel shrinkage, 10 ± 4 mm(2) vs. non–vessel shrinkage, 11 ± 4 mm(2); P = 0.04). Independent predictors of vessel shrinkage were insulin requirements (odds ratio 4.6 [95% CI 1.40–15.10]; P = 0.01), glycated hemoglobin (1.5 [1.05–2.10]; P = 0.02), apolipoprotein B (0.96 [0.94–0.98]; P < 0.001), hypertension (3.7 [1.40–10.30]; P = 0.009), number of diseased vessels (5.6 [2.50–12.50]; P < 0.001), and prior revascularization (17.5 [6.50–46.90]; P < 0.001). CONCLUSIONS—This serial IVUS study suggests that progression of coronary artery disease in patients with type 2 diabetes may be mainly attributed to vessel shrinkage. Besides, vessel shrinkage is influenced by insulin requirements and metabolic control and is associated with more advanced coronary atherosclerosis.