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Coronary atherosclerosis is already ongoing in pre-diabetic status: Insight from intravascular imaging modalities

World Journal of Diabetes 2015年第1期6卷 184-191页

作者： Osamu Kurihara Masamichi Takano yoshihiko seino Wataru Shimizu Kyoichi Mizuno Cardiovascular Center Chiba-Hokusoh Hospital Nippon Medical School Division of Cardiology Nippon Medical School Mitsukoshi Health and Welfare Foundation

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 cholesterolfor 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.

关键词： Diabetes Prediabetes Statin therapy Coronary artery disease Intravascular imaging modality

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Neoatherosclerosis:Coronary stents seal atherosclerotic lesions but result in making a new problem of atherosclerosis

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World Journal of Cardiology 2015年第11期7卷 776-783页

作者： Hidenori Komiyama Masamichi Takano Noritake Hata yoshihiko seino Wataru Shimizu Kyoichi Mizuno Cardiovascular Center Chiba Hokusou HospitalNippon Medical School Cardiology Nippon Medical School Mitsukoshi Health and Welfare Foundation

Chronic inflammation of the native vessel wall with infiltration of lipid-laden foamy macrophages through impaired endothelium results in atherosclerosis. Percutaneous coronary intervention, including metallic stent implantation, is now widely utilized for the treatment of atherosclerotic lesions of the coronary artery. Baremetal stents and the subsequently developed drugeluting stents seal the atherosclerosis and resolve lumen stenosis or obstruction of the epicardial coronary artery and myocardial ischemia. After stent implantation, neointima proliferates within the stented segment. Chronic inflammation caused by a foreign body reaction to the implanted stent and subsequent neovascularization, which is characterized by the continuous recruitment of macrophages into the vessel, result in the transformation of the usual neointima into an atheromatous neointima. Neointima with an atherosclerotic appearance, such as that caused by thin-cap fibroatheromas, is now recognized as neoatherosclerosis, which can sometimes cause in-stent restenosis and acute thrombotic occlusion originating from the stent segment following disruption of the atheroma. Neoatherosclerosis is emerging as a new coronary stent-associated problem that has not yet been resolved. In this review article, we will discuss possible mechanisms, clinical challenges, and the future outlook of neoatherosclerosis.

关键词： Neoatherosclerosis Percutaneous coronary intervent

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