The aim of the present study was to compare the presence and progression of coronary atherosclerosis as well as associated arterial wall remodelling between patients with diabetes and metabolic syndrome to those with neither condition. The study cohort was composed of patient data pooled from 7 clinical trials involving 3,459 patients who underwent serial intravascular ultrasound imaging to evaluate atheroma progression in patients with established coronary artery disease. Although patients with metabolic syndrome had the largest number of individual cardiovascular risk factors, patients with diabetes showed a more developed atherosclerosis process within the arterial wall. Moreover, there was no greater detrimental effect in patients with concomitant presence of diabetes and metabolic syndrome. However, results reported differences in the arterial remodelling pattern. For instance, even though the atherosclerosis burden was not greater in individuals with the metabolic syndrome than that observed in patients with neither condition, metabolic syndrome was associated with larger vessel dimensions. In contrast, diabetes was associated with vascular constriction and small lumen volumes. These findings suggested that diabetes is more atherogenic than the metabolic syndrome despite the presence of fewer individual risk factors.
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