The Role Of Abnormal Glucose Metabolism In Progression Of De Novo Coronary Artery Lesion

Objective: According to China Cardiovascular Disease Report 2018,290 million people in China suffer from cardiovascular disease.Diabetes is an independent risk factor for cardiovascular disease,number of patients with diabetes and coronary heart disease is increasing.This study intends to explore the relationship between abnormal glucose metabolism and progression of de novo coronary artery lesion by analyzing clinical data from a multi-factor retrospective analysis of coronary plaque progression(RIPPER)in China.Methods: Retrospectively analysis data from the RIPPER study.From January 2010 to July 2016,a total of 1059 patients were included according to enrolled criteria.Quantitative coronary angiography(QCA)analysis was used to determine the lesion progression in follow-up coronary artery angiography compared with baseline.Further analysis including:1.Single factor analysis of general conditions,comorbidities,medication and laboratory findings;2.QCA Analysis of de novo coronary artery lesion;3.Interactive analysis between risk factors of coronary heart disease between and abnormal glucose metabolism based on rate of progression of de novo coronary artery lesion;4.Multivariate analysis of progression of de novo coronary artery lesion based on binary logistics regression and LASSO regression;5.Propensity score matching analysis based on 2-hour postprandial glucose.Results:1.Among 1059 patients,a total of 150 patients(14.2%)developed de novo coronary artery lesion progression.Compared with the patients in non-progressive group,those in progression group had higher proportion of males,higher follow-up C-reactive protein,higher 2-hour postprandial glucose at the baseline and more coronary artery lesions.2.In QCA analysis,a total of 1,531 de novo lesions were recorded in 1059 patients.QCA analysis showed significant differences in reference vessel diameter,rate of stenosis and number of lesions between two groups.Baseline stent implantation in the vessel of de novo lesion did not differ between progressive and non-progressive groups.3.Interactive analysis shows that the incidence of progression of de novo coronary artery lesion in patients with normal glucose metabolism group,pre-diabetic state group and diabetic group was 11.4%,16.1%,18.4%,respectively.In the presence of risk factors of coronary heart disease such as gender(male),high low-density lipoprotein and high blood pressure,as the abnormal state of glucose metabolism worsens,the proportion of progression increases significantly.4.Both logistics regression and LASSO regression suggested that baseline2-hour postprandial glucose,number of lesions,gender were independent risk factors for progression of de novo coronary artery lesion.5.Propensity score matching analysis revealed that after excluding confounding factors such as blood pressure,lipid metabolism and the number of lesions,higher 2-hour postprandial glucose still has significant difference in progression rate of novo coronary artery lesion.Conclusions: 2-hour postprandial glucose is closely related to the progression of de novo coronary artery lesion.Gender,unsatisfied management of low-density lipoprotein and blood pressure may further increase the incidence of de novo coronary artery lesion progression.