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Low serum docosahexaenoic acid is associated with progression of coronary atherosclerosis in statin-treated patients with diabetes mellitus: results of the treatment with statin on atheroma regression evaluated by intravascular ultrasound with virtual histology (TRUTH) study

Tsuyoshi Nozue1*, Shingo Yamamoto2, Shinichi Tohyama3, Kazuki Fukui4, Shigeo Umezawa5, Yuko Onishi5, Tomoyuki Kunishima6, Akira Sato7, Toshihiro Nozato8, Shogo Miyake9, Youichi Takeyama10, Yoshihiro Morino11, Takao Yamauchi12, Toshiya Muramatsu13, Kiyoshi Hibi14, Mitsuyasu Terashima15 and Ichiro Michishita1

Author Affiliations

1 Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, 132 Katsura-cho, Sakae-ku, Yokohama 247-8581, Japan

2 Department of Cardiology, Tsurumi Nishiguchi Hospital, Yokohama Japan

3 Department of Cardiology, Yokohama Seamen’s Insurance Hospital, Yokohama Japan

4 Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama Japan

5 Department of Cardiology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan

6 Fourth Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki Japan

7 Cardiovascular Center, Yokosuka Kyosai Hospital, Yokosuka Japan

8 Department of Cardiology, National Hospital Organization, Disaster Medical Center, Tokyo Japan

9 Department of Cardiology, Ebina General Hospital, Ebina, Japan

10 Division of Cardiology, Showa University Fujigaoka Rehabilitation Hospital, Yokohama, Japan

11 Department of Cardiology, Tokai University School of Medicine, Isehara, Japan

12 Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan

13 Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan

14 Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan

15 Cardiovascular Imaging Center, Toyohashi, Japan

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Cardiovascular Diabetology 2014, 13:13  doi:10.1186/1475-2840-13-13

Published: 13 January 2014



Diabetes mellitus (DM) accelerates plaque progression despite the use of statin therapy. The purpose of the present study was to evaluate the determinants of atheroma progression in statin-treated patients with DM.


Coronary atherosclerosis in nonculprit lesions in a vessel undergoing percutaneous coronary intervention (PCI) was evaluated using virtual histology intravascular ultrasound. The study included 50 patients with DM who had been taking statin therapy for 8 months at the time of PCI.


Twenty-six patients (52%) showed atheroma progression (progressors) and the remaining 24 patients (48%) showed atheroma regression (regressors) after 8 months of follow-up. Fewer progressors than regressors received intensive lipid-lowering therapy with pitavastatin (31% vs. 50%, p = 0.17) and the frequency of insulin use was higher in progressors (31% vs. 13%, p = 0.18). However, neither of these differences reached statistical significance. Risk factor control at baseline and at the 8-month follow-up did not differ between the 2 groups except for serum levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Univariate regression analysis showed that serum EPA (r = -0.317, p = 0.03) and DHA (r = -0.353, p = 0.02) negatively correlated with atheroma progression. Multivariate stepwise regression analysis showed that low serum DHA and pravastatin use were significant independent predictors for atheroma progression during statin therapy (DHA: β = -0.414, type of statin: β = -0.287, p = 0.001).


Low serum DHA is associated with progression of coronary atherosclerosis in statin-treated patients with DM.

Trial registration

UMIN Clinical Trials Registry, UMIN ID: C000000311.

Atheroma; Coronary atherosclerosis; Diabetes mellitus; Statin; Virtual histology intravascular ultrasound