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Quantitative Coronary Angiographic Studies of Patients With Angina Pectoris and Impaired Glucose Tolerance

Division of Cardiology, Department of Medicine, National Cardiovascular Center, Osaka, Japan

Address correspondence and reprint requests to Shunichi Miyazaki, MD, PhD, FACC, Division of Cardiology, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan. E-mail: smiyazak{at}hsp.ncvc.go.jp

OBJECTIVE—We investigated the morphological characteristics of coronary arteries in patients with impaired glucose tolerance (IGT) using computer-assisted quantitative coronary angiography. IGT is an independent risk factor for cardiovascular disease. However, the morphological changes developing in the coronary arteries of patients with IGT remain unknown.

RESEARCH DESIGN AND METHODS—A total of 534 patients with angina pectoris were studied. Of these, 144 patients were being treated for diabetes. The remaining 390 patients were classified as follows depending on the results of a 75-g oral glucose tolerance test: normal glucose tolerance (NGT) (n = 117), impaired fasting glucose (n = 3), IGT (n = 136), and diabetes pattern (preclinical diabetes) (n = 134). The diameters of the middle section of all major coronary artery segments were measured and averaged to determine the averaged vessel diameter (AVD). We defined segments of a diameter of 1.5 mm as diseased lesions and determined the averaged lesion length (ALL).

RESULTS—AVD and ALL were significantly different among patients with IGT and those with NGT. Patients with diabetes (preclinical and/or treated) had smaller AVD and longer ALL than those with IGT. By multivariate analysis, postprandial glucose levels were shown to be independently associated with an AVD <3.0 mm and an ALL >20 mm.

CONCLUSIONS—Diffuse coronary artery narrowing develops not only in patients with diabetes but also in those with IGT. This morphological change is associated with postprandial hyperglycemia.

Abbreviations: ALL, averaged lesion length • AVD, averaged vessel diameter • FPG, fasting plasma glucose • IFG, impaired fasting glucose • IGT, impaired glucose tolerance • NGT, normal glucose tolerance • OGTT, oral glucose tolerance test • QCA, quantitative coronary angiography

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