Highlights
- •We analyze the impact of MPO on plaque progression by intravascular ultrasound.
- •Increasing MPO level contributes to plaque progression in diabetics.
- •LDL-C lowering results in less progression in diabetics with low MPO level.
- •High-dose statin prevents plaque progression in diabetics with low MPO level.
- •These benefits are diminished in diabetics with high MPO level.
Abstract
Objective
While inflammation has been proposed to contribute to the adverse cardiovascular outcome
in diabetic patients, the specific pathways involved have not been elucidated. The
leukocyte derived product, myeloperoxidase (MPO), has been implicated in all stages
of atherosclerosis. The relationship between MPO and accelerated disease progression
observed in diabetic patients has not been studied.
Methods
We investigated the relationship between MPO and disease progression in diabetic patients.
881 patients with angiographic coronary artery disease underwent serial evaluation
of atherosclerotic burden with intravascular ultrasound. Disease progression in diabetic
(n = 199) and non-diabetic (n = 682) patients, stratified by baseline MPO levels was investigated.
Results
MPO levels were similar in patients with and without diabetes (1362 vs. 1255 pmol/L,
p = 0.43). No relationship was observed between increasing quartiles of MPO and either
baseline (p = 0.81) or serial changes (p = 0.43) in levels of percent atheroma volume (PAV) in non-diabetic patients. In contrast,
increasing MPO quartiles were associated with accelerated PAV progression in diabetic
patients (p = 0.03). While optimal control of lipid and the use of high-dose statin were associated
with less disease progression, a greater benefit was observed in diabetic patients
with lower compared with higher MPO levels at baseline.
Conclusions
Increasing MPO levels are associated with greater progression of atherosclerosis in
diabetic patients. This finding indicates the potential importance of MPO pathways
in diabetic cardiovascular disease.
Keywords
Abbreviations:
CAD (coronary artery disease), DM (diabetes mellitus), EEM (external elastic membrane), HDL (high-density lipoprotein), hsCRP (high sensitivity C-reactive protein), IVUS (intravascular ultrasound), LDL (low-density lipoprotein), MPO (myeloperoxidase), PAV (percent atheroma volume)To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
November 27,
2013
Received in revised form:
November 26,
2013
Received:
June 5,
2013
Identification
Copyright
© 2013 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
