The following is a summary of “Coronary Plaque Characteristics and Underlying Mechanism of Acute Coronary Syndromes in Different Age Groups of Patients With Diabetes,” published in the November 2023 issue of Cardiology by Suzuki et al.

Elevated cardiovascular mortality rates are evident among young individuals with diabetes, yet the specific underlying pathology across different age brackets remains inadequately explored.

This study aimed to delve into plaque characteristics and the underlying pathology of acute coronary syndrome (ACS) in distinct age groups among patients with and without diabetes within a comprehensive cohort. Optical coherence tomography imaging was utilized in patients presenting ACS. The culprit plaque was categorized as plaque rupture, erosion, or calcified plaque and classified into five age groups. Optical coherence tomography assessed plaque features related to vulnerability. Among the 1,394 patients, 482 (34.6%) had diabetes. Notably, diabetic patients exhibited a higher incidence of lipid-rich plaque (71.2% vs. 64.8%, P=0.016), macrophage infiltration (72.0% vs. 62.6%, P<0.001), and cholesterol crystal deposition (27.6% vs. 19.7%, P<0.001) compared to non-diabetic counterparts. Interestingly, the prevalence of plaque erosion declined with age in both diabetic (P=0.020) and non-diabetic (P<0.001) groups. Non-diabetic patients displayed an age-associated increase in plaque rupture (P=0.004) and lipid-rich plaque (P=0.018). In contrast, diabetic patients exhibited a consistently elevated prevalence of these vulnerable plaque features from a younger age, maintaining higher levels across different age groups.

The findings suggest atherosclerotic changes fostering increased plaque vulnerability initiate at an earlier age among patients with diabetes, while non-diabetic individuals show a progressive rise in vulnerable plaque features with advancing age.

Source: ahajournals.org/doi/10.1161/JAHA.123.031474