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This slide
demonstrates the distribution of coronary segments by severity grade and by
categories of hyperglycemia.1 Only mildly severe (25% to 49% diameter stenosis) lesions were significantly more prevalent in patients with “mild” diabetes than they were in patients with normal plasma glucose and were as prevalent as in the WHO-defined patients with diabetes.1 Patients with higher numbers of normal segments had a greater likelihood of being normoglycemic.1 Patients with mildly diseased segments were generally more likely to have “mild” diabetes (1997 ADA definition – fasting plasma glucose (FPG)>126 mg/dL).1 It has been previously thought that patients with T2DM have more severe atherosclerotic disease. Many patients with T2DM actually have mild/moderate atherosclerotic disease.1 Mild disease is associated with softer plaque, which is in essence more vulnerable to rupture. This finding may explain the increased event rate in patients with diabetes, even in those who are asymptomatic.1 1. Ledru F, Ducimetiere P, Battaglia S, et al. New diagnostic criteria for diabetes and coronary artery disease: insights from an angiographic study. J Am Coll Cardiol. 2001;37(6):1543-1550. |