Reduced Glomerular Filtration Rate Is Associated with Atheroma Progression in Early-stage Diabetes Patients with Coronary Artery Disease--Sub-analysis from DIANA study

publisher[Abstract] Background: With strong links among chronic kidney disease (CKD), diabetes, and cardiovascular mortality, the need for effective risk stratification and management of diabetic patients has emerged. The aim of the present study was to characterize CKD and assess the impact ofrenal function and effects of glycemic control on atheroma progression in diabetic patients with coronary artery disease (CAD). Methods : Early-stage diabetic patients with CAD in the DIANA study (n＝301) was stratified according to the presence of reduced glomerular filtration rate (GFR, ＜60 ml/min). Clinical characteristics and metabolic data were compared between the two groups. Atheroma progression was assessed one year after treatment by quantitative coronary angiography and the impact of glycemic improvement was analyzed. Results : Patients with reduced GFR (32% of the cohort)were older (p＜0.01)and showed high preva-lence of impaired glucose tolerance (IGT) (p＝0.03). They also showed significantly smaller vessel size at baseline. There were trends toward less improvement in the glycemic status and less increase of HDL cholesterol in patients with reduced GFR (p＝0.09 and 0.05, respectively). In patients with non-reduced GFR, antiatherosclerotic effects were observed in patients achieving improvement of the glycemic status (p＝0.02). In contrast, atheroma progression was similar between reduced-GFR patients with and without optimal glycemic control (p＝0.24). Conclusions : While glycemic control was associated with less atheroma progression in early-stage diabetic patients with non-reduced GFR, this positive impact was diminished in those with reduced GFR. The present findings may suggest a more resistant substrate of coronary atherosclerosis in diabetic patients with CKD and the need for strict risk factor management to prevent atheroma progression