Intravascular ultrasound morphology of culprit lesions and clinical demographics in patients with acute coronary syndrome in relation to low-density lipoprotein cholesterol levels at onset

• Published in: Heart and vessels Vol. 29; no. 5; pp. 584 - 595
• Main Authors: Takaoka, Naoko, Tsujita, Kenichi, Kaikita, Koichi, Hokimoto, Seiji, Yamanaga, Kenshi, Komura, Naohiro, Chitose, Tadasuke, Ono, Takamichi, Mizobe, Michio, Horio, Eiji, Sato, Koji, Nakayama, Naoki, Saito, Michiyo, Iwashita, Satomi, Kojima, Sunao, Tayama, Shinji, Sugiyama, Seigo, Nakamura, Sunao, Ogawa, Hisao
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.09.2014
• Subjects: Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - epidemiology; Aged; Aged, 80 and over; Angina, Stable - diagnostic imaging; Angina, Stable - epidemiology; Biomarkers - blood; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Case-Control Studies; Chi-Square Distribution; Cholesterol, LDL - blood; Comorbidity; Coronary Vessels - diagnostic imaging; Cross-Sectional Studies; Diabetes Mellitus - epidemiology; Dyslipidemias - blood; Dyslipidemias - epidemiology; Female; Humans; Japan - epidemiology; Logistic Models; Male; Medicine; Medicine & Public Health; Middle Aged; Multivariate Analysis; Odds Ratio; Original Article; Plaque, Atherosclerotic; Predictive Value of Tests; Risk Factors; Ultrasonography, Interventional; Vascular Surgery; Lipids; Residual risk; Coronary disease; Risk factor; Ultrasonics
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-013-0401-7

Despite current standards of care aimed at achieving targets for low-density lipoprotein cholesterol (LDL-C), many patients remain at high residual risk of cardiovascular events. We sought to assess the LDL-C-dependent differences in culprit intravascular ultrasound (IVUS) morphologies and clinical characteristics in patients with acute coronary syndrome (ACS). Eighty-six consecutive ACS patients whose culprit lesions imaged by preintervention IVUS were divided into two groups based on the fasting LDL-C level on admission: a low-LDL-C group (LDL-C <2.6 mmol/l, n = 45) and a high-LDL-C group (LDL-C ≥2.6 mmol/l, n = 41). Patients with stable angina with LDL-C <2.6 mmol/l ( n = 30) were also enrolled as an age- and gender-matched control. The low-LDL-C ACS group was significantly older (72 ± 12 vs 64 ± 14 years, P = 0.007) and more diabetic (47 % vs 15 %, P = 0.001). Importantly, IVUS morphologies were comparable between low- and high-LDL-C ACS groups (all P not significant), whereas culprit plaque was more hypoechoic and less calcified in the low-LDL-C ACS group than in the low-LDL-C stable angina group. Furthermore, compared with the low-LDL-C ACS nondiabetic group, the low-LDL-C ACS diabetic group was more obese, more triglyceride rich (1.3 ± 0.6 vs 0.9 ± 0.4 mmol/l, P = 0.003), and more endothelially injured, but no different for the culprit IVUS morphologies. In multivariate analysis, diabetes was independently associated with a low LDL-C level on admission in patients with ACS. There was no relationship between the LDL-C level at onset and culprit-plaque IVUS morphologies in ACS patients, although culprit plaque in the low-LDL-C ACS group was more vulnerable than in the low-LDL-C stable angina group. In patients with low-LDL-C levels, diabetes with atherogenic dyslipidemia might be the key residual risk.