Association between atherogenic index of plasma and rapid progression of coronary atherosclerosis in non-diabetic and diabetic adults: Insight from the PARADIGM study

Background: Despite a significant association of atherogenic index of plasma (AIP) with plasma atherogenicity as well as insulin resistance and new onset of diabetes, data on the risk of rapid plaque progression (RPP) of major epicardial coronary arteries related to AIP according to established diabetes is limited. Methods: This study evaluated the association between AIP and RPP according to diabetes in 1485 adults (60.9 ​± ​9.2 years, 58.9% men, 23.8% diabetes) using serial coronary computed tomography angiography. AIP was defined as the base 10 logarithm of the ratio of triglycerides to high-density lipoprotein cholesterol (mmol/L). RPP was defined as a change in percent atheroma volume (PAV) ≥1.0%/year. Results: During a median follow-up of 3.4 years, the incidence of RPP was 26.1%. Compared with non-diabetic subjects, diabetic subjects exhibited significantly higher AIP levels, larger baseline plaque burden, and higher RPP incidence. After adjusting for age, sex, hypertension, overweight or obesity, current smoking, low-density lipoprotein cholesterol and creatinine levels, baseline total PAV, and the use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, or statins, AIP (per 0.1-unit increase) was associated with the risk of RPP in non-diabetic subjects (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.01-1.13; p ​< ​0.05) but not in diabetic subjects (OR 1.04, 95% CI 0.95-1.14; p ​= ​0.430). Conclusion: AIP is independently associated with the risk of RPP in the absence of established diabetes. This finding suggests that AIP may be an effective biomarker for predicting RPP in the population of non-diabetic adults. Trial registration: ClinicalTrials.govNCT02803411.