Fig. 1: Interplay between type 2 diabetes mellitus (T2DM), acute vascular events, and plaque vulnerability.

A Schematic representation of the cohort study derived from the National Inpatient Sample (NIS) database. B, C Logistic regression analysis depicting the relationship between T2DM and ACS (B), and T2DM and acute cerebral infarction (C) in the NIS database (2016-2018). Model 1 indicates the univariate regression analysis; Model 2 is adjusted for age, gender, and T2DM; Model 3 is further adjusted for additional confounders including obesity, hyperlipidemia, COPD (chronic obstructive pulmonary disease), hypertension, and atrial fibrillation. (Error bars, which extend from the center of the red square, represent the 95% confidence interval for odds ratio. The center for the error bars is the point estimate of the odds ratio for each variable. n = 21400282 subjects). D–I Comparative analyses of various plaque and vascular characteristics, including external elastic membrane (EEM) - cross-sectional area (CSA). (D, data presented as mean ± SD, P = 0.1678), lesion length (E, data presented as mean ± SD, P = 0.3074), fibrous cap thickness (F, data presented as mean ± SD, *P = 0.017), plaque burden (G, data presented as mean ± SD, ***P = 0.0002), minimum lumen area (H, data presented as mean ± SD, **P = 0.005), and lipid necrotic core area (I, data presented as mean ± SD, P = 0.6005), between non-T2DM and T2DM subjects. J Representative IVUS (intravascular ultrasound) images of a normal coronary artery, a vulnerable plaque, and a stable plaque. The IVUS catheter, blood flow, fibrous cap, and lipid necrotic core are indicated in brown, red, yellow, and blue, respectively. K Logistic regression analysis revealing the relationship between T2DM and plaque vulnerability in the cohort study. Model 1 indicates the univariate regression analysis; Model 2 is adjusted for age, gender, and T2DM; Model 3 is further adjusted for T2DM, age, gender, BMI, LDL, smoking, hypertension, and serum creatinine levels. (Error bars, which extend from the center of the red square, represent the 95% confidence interval for odds ratio. The center for the error bars is the point estimate of the odds ratio for each variable. n = 21400282 subjects. D, E Two-tailed unpaired Student t-test, F, G, H, I Two-tailed unpaired Student t-test with Welch’s correction). Source data are provided as a Source Data file.