Background: Glucose fluctuation has been recognized as a residual risk apart from dyslipidemia for the development\nof coronary artery disease (CAD). This study aimed to investigate the association between glucose fluctuation and\ncoronary plaque morphology in CAD patients.\nMethods: This prospective study enrolled 72 consecutive CAD patients receiving adequate lipid-lowering therapy.\nThey were divided into 3 tertiles according to the mean amplitude of glycemic excursions (MAGE), which represents\nglucose fluctuation, measured by continuous glucose monitoring (tertile 1; <49.1, tertile 2; 49.1 ~ 85.3, tertile 3; >85.3).\nMorphological feature of plaques were evaluated by optical coherence tomography. Lipid index (LI) (mean lipid\narc Ã?â?? length), fibrous cap thickness (FCT), and the prevalence of thin-cap fibroatheroma (TCFA) were assessed in\nboth culprit and non-culprit lesions.\nResults: In total, 166 lesions were evaluated. LI was stepwisely increased according to the tertile of MAGE (1958 Ã?± 974\n[tertile 1] vs. 2653 Ã?± 1400 [tertile 2] vs. 4362 Ã?± 1858 [tertile 3], p <0.001), whereas FCT was the thinnest in the tertile 3\n(157.3 Ã?± 73.0 ?m vs. 104.0 Ã?± 64.1 ?m vs. 83.1 Ã?± 34.7 ?m, p <0.001, respectively). The tertile 3 had the highest prevalence\nof TCFA. Multiple linear regression analysis showed that MAGE had the strongest effect on LI and FCT (standardized\ncoefficient ? = 0.527 and ?0.392, respectively, both P <0.001). Multiple logistic analysis identified MAGE as the only\nindependent predictor of the presence of TCFA (odds ratio 1.034; P <0.001).\nConclusions: Glucose fluctuation and hypoglycemia may impact the formation of lipid-rich plaques and thinning\nof fibrous cap in CAD patients with lipid-lowering therapy
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