Published online Feb 15, 2015. doi: 10.4239/wjd.v6.i1.184
Peer-review started: August 29, 2014
First decision: September 30, 2014
Revised: October 22, 2014
Accepted: December 16, 2014
Article in press: December 17, 2014
Published online: February 15, 2015
Diabetes mellitus is a powerful risk factor of coronary artery disease (CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD including cardiovascular events, a new guideline has been proposed for the treatment of blood cholesterol for primary prevention of cardiovascular events. This guideline recommends aggressive lipid-lowering statin therapy for primary prevention in diabetes and other patients. The ultimate goal of patient management is to inhibit progression of systemic atherosclerosis and prevent fatal cardiovascular events such as acute coronary syndrome (ACS). Because disruption of atherosclerotic coronary plaques is a trigger of ACS, the high-risk atheroma is called a vulnerable plaque. Several types of novel diagnostic imaging technologies have been developed for identifying the characteristics of coronary atherosclerosis before the onset of ACS, especially vulnerable plaques. According to coronary angioscopic evaluation, atherosclerosis severity and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable to that in diabetic patients. In addition, pharmacological intervention by statin therapy changed plaque color and complexity, and the dynamic changes in plaque features are considered plaque stabilization. In this article, we review the findings of atherosclerosis in prediabetes, detected by intravascular imaging modalities, and the therapeutic implications.
Core tip: Coronary artery disease is the principal cause of death and disability in not only diabetes but also prediabetes patients. Aggressive statin therapy is an established method of primary prevention of cardiovascular disease events in diabetic patients. According to the findings of coronary imaging modalities detecting atherosclerotic lesions, statin therapy in prediabetes may be beneficial for reducing atherosclerotic cardiovascular risk.