Characterization of lipidic plaque features in association with LDL-C<70 mg/dL and lipoprotein(a) <50 mg/dL

IF 4.6 3区医学 Q2 PHARMACOLOGY & PHARMACY Journal of clinical lipidology Pub Date : 2025-05-01 Epub Date: 2025-01-03 DOI:10.1016/j.jacl.2024.12.019

Daisuke Shishikura MD, PhD , Yu Kataoka MD, PhD , Stephen J. Nicholls MBBS , Kausik K. Ray FMedSci , Rishi Puri MBBS, PhD , Hirofumi Kusumoto MD , Yohei Yamauchi MD, PhD , Kazushi Sakane MD, PhD , Tomohiro Fujisaka MD, PhD , Hideaki Morita MD, PhD , Kota Murai MD , Takamasa Iwai MD , Kenichiro Sawada MD , Hideo Matama MD , Satoshi Honda MD, PhD , Masashi Fujino MD, PhD , Shuichi Yoneda MD, PhD , Kensuke Takagi MD, PhD , Kazuhiro Nakao MD, PhD , Fumiyuki Otsuka MD, PhD , Masaaki Hoshiga MD, PhD

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Abstract

BACKGROUND

The ongoing residual cardiovascular risks despite lowering low-density lipoprotein cholesterol (LDL-C) levels suggest the need to identify additional drivers associated with atherosclerosis. Circulating lipoprotein(a) [Lp(a)] promotes formation of foam cells via its proatherogenic properties. However, whether a lower Lp(a) level in combination with favorable LDL-C control could induce a more stable form of disease remains unknown. Near-infrared spectroscopy (NIRS) generates maximum lipid-core burden index in 4 mm (MaxLCBI_4 mm) which is a histologically validated measure of lipidic plaque material in vivo. Therefore, the current study employed NIRS imaging to characterize lipidic plaque in association with LDL-C < 70 mg/dL and Lp(a) <50 mg/dL.

METHODS

We analyzed 439 patients with coronary artery disease (CAD) (554 de-novo target lesions receiving percutaneous coronary intervention) in the REASSURE-NIRS registry (NCT04864171). Clinical characteristics and NIRS-derived MaxLCBI₄_mm were compared among 4 groups according to LDL-C of 70 mg/dL and Lp(a) of 50 mg/dL.

RESULTS

Almost one-third of study subjects (33.4%) exhibited both LDL-C < 70 mg/dL and Lp(a) <50 mg/dL. They were more likely male with a lower frequency of acute coronary syndrome and lipid lowering therapies were more frequently used in those with LDL-C < 70 mg/dL and Lp(a) <50 mg/dL. On NIRS imaging analysis, a smaller MaxLCBI₄_mm (P < .001) and a lower frequency of MaxLCBI₄_mm ≥400 (P = .001) were observed in those with both LDL-C < 70 mg/dL and Lp(a) <50 mg/dL. On multivariable logistic regression analysis, the coexistence of these 2 lipid controls showed an approximately 70% lower risk (adjusted odds ratio: 0.30; 95% CI: 0.13-0.68) of MaxLCBI₄_mm ≥400 compared with the reference group (LDL-C ≥ 70 mg/dL and Lp(a) ≥50 mg/dL).

CONCLUSION

Our findings suggest circulating Lp(a) as a potential therapeutic target to stabilize coronary atherosclerosis in CAD patients who achieved LDL-C < 70 mg/dL.

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与LDL-C<70 mg/dL和脂蛋白(a) <50 mg/dL相关的脂质斑块特征表征。

背景：尽管降低了低密度脂蛋白胆固醇（LDL-C）水平，但仍存在剩余心血管风险，这表明有必要确定与动脉粥样硬化相关的其他驱动因素。循环脂蛋白(a) [Lp(a)]通过其致动脉粥样硬化特性促进泡沫细胞的形成。然而，较低的Lp(a)水平与有利的LDL-C控制是否能诱导更稳定的疾病形式仍不清楚。近红外光谱（NIRS）在4 mm内产生最大脂质核心负荷指数（MaxLCBI4 mm），这是一种组织学上有效的体内脂质斑块物质测量方法。因此，目前的研究采用NIRS成像来表征与LDL-C相关的脂质斑块 方法：我们分析了reas- NIRS登记（NCT04864171）中的439例冠状动脉疾病（CAD）患者（554例接受经皮冠状动脉介入治疗的新生靶病变）。以LDL-C为70 mg/dL， Lp(a)为50 mg/dL，比较4组患者的临床特征和nirs衍生的MaxLCBI4mm。结果:几乎三分之一的研究对象(33.4%)表现出低密度 4毫米(P 4毫米≥400 (P = 措施)被观察到在那些与低密度 4毫米≥400与参照组(低密度 ≥70  mg / dL和Lp (a)≥50 mg / dL)。结论：我们的研究结果表明，循环Lp(a)是稳定冠心病患者LDL-C水平的潜在治疗靶点

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.