Greater plaque burden and cholesterol content may explain an increased incidence of non-culprit events in diabetic patients: a Lipid-Rich Plaque substudy

Pierluigi Demola, Carlo Di Mario, Rebecca Torguson, Tim Ten Cate, Gabriele Bambagioni, Ziad Ali, William Skinner, Andre Artis, Cheng Zhang, Hector M. Garcia-Garcia, Gheorghe Doros, Gary S. Mintz, Ron Waksman

Research output: Contribution to journalArticlepeer-review


Aims: Diabetes mellitus (DM) is associated with increased cardiovascular morbidity and mortality. The multicentre, prospective Lipid-Rich Plaque trial (LRP) examined non-culprit (NC) non-obstructive coronary segments with a combined near-infrared spectroscopy (NIRS)-intravascular ultrasound (IVUS) catheter. This study assessed the differences in NC plaque characteristics and their influence on major adverse cardiac events (MACE) in diabetic and non-diabetic patients. Methods and results: Patients with known DM status were divided into no diabetes, diabetes not treated with insulin (non-ITDM), and insulin-treated diabetes (ITDM). The association between presence and type of DM and NC-MACE was assessed at both the patient and coronary segment levels by Cox proportional regression modelling. Out of 1552 patients enrolled, 1266 who had their diabetes status recorded were followed through 24 months. Female sex, hypertension, chronic kidney disease, peripheral vascular disease, and high body mass index were significantly more frequent in diabetic patients. The ITDM group had more diseased vessels, at least one NC segment with a maxLCBI4mm ≥400 in 46.2% of patients, and maxLCBI4mm ≥400 in nearly one out of six Ware segments (15.2%, 125/824 segments). The average maxLCBI4mm significantly increased from non-diabetic patients (NoDM) to non-insulin-treated diabetic patients (non-ITDM) to insulin-treated diabetic patients (ITDM; 137.7 ± 161.9, 154.8 ± 173.6, 182.9 ± 193.2, P < 0.001, respectively). In patients assigned to follow-up (692 ± 129 days), ITDM doubled the incidence of NC-MACE compared with the absence of diabetes (15.7% vs. 6.9%, P = 0.0008). The presence of maxLCBI4mm>400 further increased the NC-MACE rate to 21.6% (Kaplan-Meier estimate). Conclusion: Cholesterol-rich NC plaques detected by NIRS-IVUS were significantly more frequent in diabetic patients, especially those who were insulin-treated, and were associated with an increased NC-MACE during follow-up.

Original languageEnglish
Pages (from-to)1098-1107
Number of pages10
JournalEuropean Heart Journal Cardiovascular Imaging
Issue number8
StatePublished - 1 Aug 2022
Externally publishedYes


  • coronary atherosclerosis
  • diabetes mellitus
  • intravascular ultrasound imaging
  • near-infrared spectroscopy
  • plaque vulnerability


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