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

Diabetes mellitus is a powerful risk factor of coronaryartery disease （CAD）, leading to death and disability.In recent years, given the accumulating evidence thatprediabetes is also related to increasing risk of CADincluding cardiovascular events, a new guideline hasbeen proposed for the treatment of blood cholesterolfor primary prevention of cardiovascular events. Thisguideline recommends aggressive lipid-lowering statintherapy for primary prevention in diabetes and otherpatients. The ultimate goal of patient managementis to inhibit progression of systemic atherosclerosisand prevent fatal cardiovascular events such as acutecoronary syndrome （ACS）. Because disruption ofatherosclerotic coronary plaques is a trigger of ACS,the high-risk atheroma is called a vulnerable plaque.Several types of novel diagnostic imaging technologieshave been developed for identifying the characteristicsof coronary atherosclerosis before the onset of ACS,especially vulnerable plaques. According to coronaryangioscopic evaluation, atherosclerosis severity andplaque vulnerability were more advanced in prediabeticthan in nondiabetic patients and comparable to thatin diabetic patients. In addition, pharmacologicalintervention by statin therapy changed plaque color andcomplexity, and the dynamic changes in plaque featuresare considered plaque stabilization. In this article, wereview the findings of atherosclerosis in prediabetes,detected by intravascular imaging modalities, and thetherapeutic implications.