Low-density lipoprotein and noncalcified coronary plaque composition in patients with newly diagnosed coronary artery disease on computed tomographic angiography

Aggravating effect of abnormal low-density protein cholesterol level on coronary atherosclerotic plaque in type 2 diabetes mellitus patients assessed by coronary computed tomography angiography

BACKGROUND

The abnormal low-density protein cholesterol (LDL-C) level in the development of atherosclerosis is often comorbid in individuals with type 2 diabetes mellitus(T2DM). This study aimed to investigate the aggravating effect of abnormal LDL-C levels on coronary artery plaques assessed by coronary computed tomography angiography (CCTA) in T2DM.

MATERIALS AND METHODS

This study collected 3439 T2DM patients from September 2011 to February 2022. Comparative analysis of differences in coronary plaque characteristics was performed for the patients between the normal LDL-C level group and the abnormal LDL-C level group. Factors with P < 0.1 in the univariable linear regression analyses were included in the multivariable linear stepwise regression.

RESULTS

A total of 2820 eligible T2DM patients were included and identified as the normal LDL-C level group (n = 973) and the abnormal LDL-C level group (n = 1847). Compared with the normal LDL-C level group, both on a per-patient basis and per-segment basis, patients with abnormal LDL-C level showed more calcified plaques, partially calcified plaques, low attenuation plaques, positive remodellings, and spotty calcifications. Multivessel obstructive disease (MVD), nonobstructive stenosis (NOS), obstructive stenosis (OS), plaque involvement degree (PID), segment stenosis score (SSS), and segment involvement scores (SIS) were likely higher in the abnormal LDL-C level group than that in the normal LDL-C level group (P < 0.001). In multivariable linear stepwise regression, the abnormal LDL-C level was validated as an independent positive correlation with high-risk coronary plaques and the degree and extent of stenosis caused by plaques (low attenuation plaque: β = 0.116; positive remodelling: β = 0.138; spotty calcification: β = 0.091; NOS: β = 0.427; OS: β = 0.659: SIS: β = 1.114; SSS: β = 2.987; PID: β = 2.716, all P value < 0.001).

CONCLUSIONS

Abnormal LDL-C levels aggravate atherosclerotic cardiovascular disease (ASCVD) in patients with T2DM. Clinical attention deserves to be caught by the tailored identification of cardiovascular risk categories in T2DM individuals and the achievement of the corresponding LDL-C treatment goal.

Evaluation of peri-plaque pericoronary adipose tissue attenuation in coronary atherosclerosis using a dual-layer spectral detector CT

Purpose

This study aimed to evaluate the differences between pericoronary adipose tissue (PCAT) attenuation at different measured locations in evaluating coronary atherosclerosis using spectral computed tomography (CT) and to explore valuable imaging indicators.

Methods

A total of 330 patients with suspicious coronary atherosclerosis were enrolled and underwent coronary CT angiography with dual-layer spectral detector CT (SDCT). Proximal and peri-plaque fat attenuation index (FAI) of stenosis coronary arteries were measured using both conventional images (CIs) and virtual monoenergetic images (VMIs) ranging from 40 keV to 100 keV. The slopes of the spectral attenuation curve (λ) of proximal and peri-plaque PCAT at three different monoenergetic intervals were calculated. Additionally, peri-plaque FAI on CI and virtual non-contrast images, and effective atomic number were measured manually.

Results

A total of 231 coronary arteries with plaques and lumen stenosis were finally enrolled. Peri-plaque FAICI and FAIVMI were significantly higher in severe stenosis than in mild and moderate stenosis (p < 0.05), while peri-plaque λ, proximal FAI, and proximal λ were not statistically different. Proximal FAI, peri-plaque FAI, and peri-plaque λ were significantly higher in low-density non-calcified plaque (LD-NCP) and non-calcified plaque (NCP) than in calcified plaque (p < 0.01). Peri-plaque FAI was the highest in the LD-NCP group, while proximal FAI was the highest in the NCP group. In severe stenosis and in LD-NCP, peri-plaque FAI was significantly higher than proximal FAI (p < 0.05). The manually measured parameters related to peri-plaque PCAT attenuation had a positive correlation with the results of peri-plaque FAI measured automatically.

Conclusion

Peri-plaque PCAT has more value in assessing coronary atherosclerosis than proximal PCAT. Peri-plaque PCAT attenuation is expected to be used as a standard biomarker for evaluating plaque vulnerability and hemodynamic characteristics.

Statin Use and Coronary Artery Calcification: a Systematic Review and Meta-analysis of Observational Studies and Randomized Controlled Trials

PURPOSE OF REVIEW

This review aimed to determine the association between statin use and coronary artery calcification (CAC), as detected by computed tomography in the general population, in previously published observational studies (OSs) and randomized controlled trials (RCTs).

RECENT FINDINGS

A systematic search until February 2022 identified 41 relevant studies, comprising 29 OSs and 12 RCTs. We employed six meta-analysis models, stratifying studies based on design and effect metrics. For cohort studies, the pooled β of the association with CAC quantified by the Agatston score was 0.11 (95% CI = 0.05; 0.16), with an average follow-up time per person (AFTP) of 3.68 years. Cross-sectional studies indicated a pooled odds ratio of 2.11 (95% CI = 1.61; 2.78) for the presence of CAC. In RCTs, the pooled standardized mean differences (SMDs) for CAC, quantified by Agatston score or volume, over and AFTP of 1.25 years were not statistically significant (SMD =  - 0.06, 95% CI =  - 0.19; 0.06 and SMD = 0.26, 95% CI =  - 0.66; 1.19), but significantly different (p-value = 0.04). Meta-regression and subgroup analyses did not show any significant differences in pooled estimates across covariates. The effect of statins on CAC differs across study designs. OSs demonstrate associations between statin use and higher CAC scores and presence while being prone to confounding by indication. Effects from RCTs do not reach statistical significance and vary depending on the quantification method, hampering drawing conclusions. Further investigations are required to address the limitations inherent in each approach.

Focal pericoronary adipose tissue attenuation is related to plaque presence, plaque type, and stenosis severity in coronary CTA

Objectives

To investigate the association of pericoronary adipose tissue mean attenuation (PCAT_MA) with coronary artery disease (CAD) characteristics on coronary computed tomography angiography (CCTA).

Methods

We retrospectively investigated 165 symptomatic patients who underwent third-generation dual-source CCTA at 70kVp: 93 with and 72 without CAD (204 arteries with plaque, 291 without plaque). CCTA was evaluated for presence and characteristics of CAD per artery. PCAT_MA was measured proximally and across the most severe stenosis. Patient-level, proximal PCAT_MA was defined as the mean of the proximal PCAT_MA of the three main coronary arteries. Analyses were performed on patient and vessel level.

Results

Mean proximal PCAT_MA was −96.2 ± 7.1 HU and −95.6 ± 7.8HU for patients with and without CAD (p = 0.644). In arteries with plaque, proximal and lesion-specific PCAT_MA was similar (−96.1 ± 9.6 HU, −95.9 ± 11.2 HU, p = 0.608). Lesion-specific PCAT_MA of arteries with plaque (−94.7 HU) differed from proximal PCAT_MA of arteries without plaque (−97.2 HU, p = 0.015). Minimal stenosis showed higher lesion-specific PCAT_MA (−94.0 HU) than severe stenosis (−98.5 HU, p = 0.030). Lesion-specific PCAT_MA of non-calcified, mixed, and calcified plaque was −96.5 HU, −94.6 HU, and −89.9 HU (p = 0.004). Vessel-based total plaque, lipid-rich necrotic core, and calcified plaque burden showed a very weak to moderate correlation with proximal PCAT_MA.

Conclusions

Lesion-specific PCAT_MA was higher in arteries with plaque than proximal PCAT_MA in arteries without plaque. Lesion-specific PCAT_MA was higher in non-calcified and mixed plaques compared to calcified plaques, and in minimal stenosis compared to severe; proximal PCAT_MA did not show these relationships. This suggests that lesion-specific PCAT_MA is related to plaque development and vulnerability.

Key Points

• In symptomatic patients undergoing CCTA at 70 kVp, PCAT_MAwas higher in coronary arteries with plaque than those without plaque.

• PCAT_MAwas higher for non-calcified and mixed plaques compared to calcified plaques, and for minimal stenosis compared to severe stenosis.

• In contrast to PCAT_MAmeasurement of the proximal vessels, lesion-specific PCAT_MAshowed clear relationships with plaque presence and stenosis degree.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00330-021-07882-1.

Effects of different statins application methods on plaques in patients with coronary atherosclerosis

BACKGROUND

Discontinued application of statins may be related to adverse cardiovascular events. However, it is unclear whether different statins administration methods have effects on coronary artery plaques.

AIM

To evaluate the effects of different statins application methods on plaques in patients with coronary atherosclerosis.

METHODS

A total of 100 patients diagnosed with atherosclerotic plaque by coronary artery computed tomography were continuously selected and divided into three groups according to different statins administration methods (discontinued application group, n = 32; intermittent application group, n = 39; sustained application group, n = 29). The effects of the different statins application methods on coronary atherosclerotic plaque were assessed.

RESULTS

The volume change and rate of change of the most severe plaques were significantly reduced in the sustained application group (P ≤ 0.001). The volume change of the most severe plaques correlated positively with low-density lipoprotein (LDL-C) levels only in the sustained application group (R = 0.362, P = 0.013). There were no changes in plaques or LDL-C levels in the intermittent and discontinued application groups.

CONCLUSION

Continuous application of statins is effective for controlling plaque progression, whereas discontinued or intermittent administration of statins is not conducive to controlling plaques. Only with continuous statins administration can a reduction in LDL-C levels result in plaque volume shrinkage.

Relation of Low-Density Lipoprotein Cholesterol Level to Plaque Rupture

Statin therapy reduces low-density lipoprotein cholesterol (LDL-C), inflammation, and atherosclerotic cardiovascular disease. We investigated the association between LDL-C and statin therapy on the prevalence of plaque rupture (PR). Patients with acute coronary syndromes who underwent optical coherence tomography imaging of the culprit lesion were divided into 4 groups based on LDL-C level and statin use (Group 1: LDL-C ≤ 100 without statin; Group 2; LDL-C ≤ 100 with statin; Group 3: LDL-C > 100 with statin; Group 4: LDL-C > 100 without statin), and the prevalence of PR was compared between the groups. Among 896 patients, PR was diagnosed in 444 (49.6%) patients. The prevalence of PR was significantly different among the 4 groups (p = 0.007): it was highest in the high LDL-C without statin group and lowest in the low LDL-C without statin group (53.9% and 39.2%, respectively). Compared with the high LDL-C without statin group, the low LDL-C without statin and low LDL-C with statin groups had a significantly lower prevalence of PR (p = 0.001, p = 0.040, respectively), and the low LDL-C with statin group had a significantly higher prevalence of calcification (p = 0.037). The patients with naturally low LDL-C have the lowest risk of PR. The patients with low LDL-C achieved by statin therapy had a higher prevalence of calcification. When LDL-C level is elevated, early and aggressive treatment with statin may help to prevent PR by stabilizing plaques through calcification.

Association of lipoprotein subfractions and glycoprotein acetylation with coronary plaque burden in SLE

Objective

Subjects with SLE display an enhanced risk of atherosclerotic cardiovascular disease (CVD) that is not explained by Framingham risk. This study sought to investigate the utility of nuclear MR (NMR) spectroscopy measurements of serum lipoprotein particle counts and size and glycoprotein acetylation (GlycA) burden to predict coronary atherosclerosis in SLE.

Methods

Coronary plaque burden was assessed in SLE subjects and healthy controls using coronary CT angiography. Lipoproteins and GlycA were quantified by NMR spectroscopy.

Results

SLE subjects displayed statistically significant decreases in high-density lipoprotein (HDL) particle counts and increased very low-density lipoprotein (VLDL) particle counts compared with controls. Non-calcified coronary plaque burden (NCB) negatively associated with HDL subsets whereas it positively associated with VLDL particle counts in multivariate adjusted models. GlycA was significantly increased in SLE sera compared with controls. In contrast to high-sensitivity C reactive protein, elevations in GlycA in SLE significantly associated with NCB and insulin resistance (IR), though the association with NCB was no longer significant after adjusting for prednisone use.

Conclusions

Patients with SLE display a proatherogenic lipoprotein profile that may significantly contribute to the development of premature CVD. The results demonstrate that NMR measures of GlycA and lipoprotein profiles, beyond what is captured in routine clinical labs, could be a useful tool in assessing CVD risk in patients with SLE.

Association between hemoglobin A1c variability and subclinical coronary atherosclerosis in subjects with type 2 diabetes

AIMS

We examined the association between hemoglobin A1c (HbA1c) variability and subclinical coronary atherosclerosis in subjects with type 2 diabetes.

METHODS

We used the multidetector coronary computed tomography data collected from subjects with type 2 diabetes who did not have a history of cardiovascular disease or angina symptoms. HbA1c measurements preceding the date of cardiac imaging were retrospectively collected, and intraindividual SD (HbA1c-SD), CV and adjusted SD of HbA1c measurements were calculated. Subclinical coronary atherosclerosis was defined as calcium score >400 without any cardiac symptoms.

RESULTS

A total of 595 subjects were categorized according to the median value of each HbA1c variability indicators. The prevalence of subclinical coronary atherosclerosis was higher in higher HbA1c variability group compared with lower HbA1c variability group. Multivariable logistic regression analysis showed that higher HbA1c-SD and -CV were associated with the presence of subclinical coronary atherosclerosis, independent of mean HbA1c level in subjects with diabetes duration ≤10 years (OR [95% CI]; HbA1c-SD, 2.894 [1.105-7.584]; HbA1c-CV, 2.540 [1.022-6.316]).

CONCLUSIONS

Long-term stabilization of blood glucose level might be important in preventing subclinical coronary atherosclerosis in subjects with earlier period of type 2 diabetes.

A cross-sectional analysis of the relationship between uric acid and coronary atherosclerosis in patients with suspected coronary artery disease in China

Background

Although many studies have examined the relationship between uric acid (UA) and coronary artery disease (CAD), whether UA is an independent risk factor contributing to progression of CAD is still controversial. Whether UA plays a different role in different sexes is also unclear.

Methods

A total of 1116 individuals with suspected CAD were stratified into four groups according to their serum UA quartiles in total (men and women combined), in men, and in women. The association of UA with coronary atherosclerosis was assessed by univariable and multivariable logistic regression.

Results

In total and in women, the prevalence of any plaques and significant/severe stenosis was significantly increased with an increase in quartiles of UA (all P < 0.05). The proportion of triple-vessel disease and left main artery lesion was highest in the fourth quartile (both p < 0.05). Increasing quartiles of UA were significantly associated with a coronary artery calcium score (CACS) >10 (all P < 0.01). As UA levels increased in women, the incidence of double-vessel lesions (p = 0.017) and the proportion of mixed plaques (p = 0.022) were significantly increased. The proportion of a CACS of 0 in total, in men and women was highest in the first quartile (all P < 0.01). UA was the strongest predictor of significant stenosis, multivessel disease, and mixed plaques in women (all p < 0.05). UA was the only risk factor for mixed plaques in total (P = 0.046).

Conclusion

The level of UA was significantly associated with coronary atherosclerosis in women, but not men.

Evaluation of coronary artery disease and cardiac morphology and function in patients with hypertrophic cardiomyopathy, using cardiac computed tomography

Coronary artery disease and cardiac morphology and function were evaluated in 51 patients with hypertrophic cardiomyopathy (HCM), without typical chest pain, using cardiac computed tomography (CT). This study investigated the prevalence of coronary artery disease, the indicators of obstructive coronary stenosis, and the magnitude of left ventricular (LV) hypertrophy. The patients' mean coronary artery calcium score was 198.8 ± 312.0 and was positively correlated with the number of coronary risk factors (r = 0.32; P < 0.05). Of the 51 patients with HCM, 42 (82.4 %) had some degree of stenosis and 8 (15.7 %) had obstructive stenosis. Noncalcified and mixed plaques were detected in 14 (27.5 %) and 11 (21.6 %) patients, respectively. Multivariate logistic regression revealed that diabetes was an independent indicator of the presence of obstructive stenosis in HCM patients. Multivariate linear regression revealed that low estimated glomerular filtration rates and high triglyceride concentrations were independent indicators of higher LV mass indexes. In conclusion, cardiac CT revealed that coronary artery disease was common among patients with HCM. The presence of obstructive coronary stenosis and the magnitude of LV hypertrophy were related to the presence of diabetes, triglyceride levels, and estimated glomerular filtration rate.

Apoprotein B, small-dense LDL and impaired HDL remodeling is associated with larger plaque burden and more noncalcified plaque as assessed by coronary CT angiography and intravascular ultrasound with radiofrequency backscatter: results from the ATLANTA I study

Background

Apoprotein B–containing lipoproteins are atherogenic, but atheroprotective functions of apoprotein A–containing high‐density lipoprotein (HDL) particles are poorly understood. The association between lipoproteins and plaque components by coronary computed tomography angiography (CTA) and intravascular ultrasound with radiofrequency backscatter (IVUS/VH) has not been evaluated.

Methods and Results

Quantitative, 3‐dimensional plaque measurements were performed in 60 patients with CTA and IVUS/VH. Apoproteins, lipids, and HDL subpopulations were measured with 2‐dimensional (2D) gel electrophoresis, and correlation was assessed with univariate and multivariable models. ApoB particles were associated with a higher proportion of noncalcified plaque (NCP) and a lower proportion of calcified plaque (small, dense low‐density lipoprotein cholesterol and high‐density NCP: r=0.3, P=0.03; triglycerides and low‐density NCP: r=0.34, P=0.01). Smaller, dense, lipid‐poor HDL particles were associated with a shift from calcified plaque to NCP on CTA (α3‐HDL% and low‐density NCP: r=0.32, P=0.02) and with larger plaque volume on IVUS/VH (α4‐HDL%: r=0.41, P=0.01; α3‐HDL%: r=0.37, P=0.03), because of larger dense calcium (α4‐HDL%: r=0.37, P=0.03), larger fibrous tissue (α4‐HDL%: r=0.34, P=0.04), and larger necrotic core (α4‐HDL%: r=0.46, P<0.01; α3‐HDL%: r=0.37, P=0.03). Larger lipid‐rich HDL particles were associated with less low‐density NCP on CTA (α2‐HDL%: r=−0.34, P=0.02; α1‐HDL%: r=−0.28, P=0.05), with smaller plaque volume on IVUS/VH (pre‐α2‐HDL: r=−0.33, P=0.05; α1‐HDL%: r=−0.41, P=0.01; pre‐α2‐HDL: r=−0.33, P=0.05) and with less necrotic core (α1‐HDL: r=−0.42, P<0.01; pre‐α2‐HDL: r=−0.38, P=0.02; α2‐HDL: r=−0.35, P=0.03; pre‐α1‐HDL: r=−0.34, P=0.04). Pre‐β2‐HDL was associated with less calcification and less stenosis by both modalities.

Conclusions

ApoB and small HDL particles are associated with larger plaque burden and more noncalcified plaque, whereas larger HDL and pre‐β2‐HDL particles are associated with plaque burden and less noncalcified plaque by both CTA and IVUS/VH.

Impact of prediabetic status on coronary atherosclerosis: a multivessel angioscopic study

OBJECTIVE

To determine if prediabetes is associated with atherosclerosis of coronary arteries, we evaluated the degree of coronary atherosclerosis in nondiabetic, prediabetic, and diabetic patients by using coronary angioscopy to identify plaque vulnerability based on yellow color intensity.

RESEARCH DESIGN AND METHODS

Sixty-seven patients with coronary artery disease (CAD) underwent angioscopic observation of multiple main-trunk coronary arteries. According to the American Diabetes Association guidelines, patients were divided into nondiabetic (n = 16), prediabetic (n = 28), and diabetic (n = 23) groups. Plaque color grade was defined as 1 (light yellow), 2 (yellow), or 3 (intense yellow) based on angioscopic findings. The number of yellow plaques (NYPs) per vessel and maximum yellow grade (MYG) were compared among the groups.

RESULTS

Mean NYP and MYG differed significantly between the groups (P = 0.01 and P = 0.047, respectively). These indexes were higher in prediabetic than in nondiabetic patients (P = 0.02 and P = 0.04, respectively), but similar in prediabetic and diabetic patients (P = 0.44 and P = 0.21, respectively). Diabetes and prediabetes were independent predictors of multiple yellow plaques (NYPs ≥2) in multivariate logistic regression analysis (odds ratio [OR] 10.8 [95% CI 2.09-55.6], P = 0.005; and OR 4.13 [95% CI 1.01-17.0], P = 0.049, respectively).

CONCLUSIONS

Coronary atherosclerosis and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable between prediabetic and diabetic patients. Slight or mild disorders in glucose metabolism, such as prediabetes, could be a risk factor for CAD, as is diabetes itself.

Relationship of low- and high-density lipoproteins to coronary artery plaque composition by CT angiography

BACKGROUND

The association between lipoprotein levels and coronary plaque composition is not well understood.

OBJECTIVE

The aim of this prospective international multicenter study of statin-naive individuals was to evaluate the association of low-density lipoprotein (LDL), high-density lipoprotein (HDL), and total cholesterol (TC) to coronary plaque composition by coronary computed tomographic angiography (CTA).

METHODS

We studied 4575 individuals without known coronary artery disease not taking statin medications who underwent coronary CTA. Comparisons were made between those with high versus low LDL, HDL, TC, and non-HDL. We assessed the relationship of lipoproteins and plaques of specific composition (noncalcified [NCP], partially calcified [PCP], or calcified [CP] plaque).

RESULTS

Mean age was 57 ± 11 years (55% men). In univariable analyses, high LDL, low HDL, high TC, and high non-HDL were each associated with increased prevalence of NCPs, PCPs, and CPs (P < 0.05 for all). In multivariable analyses, high non-HDL was associated with the presence of NCP (odds ratio, 1.47; 95% CI, 1.22-1.78: P < 0.001). In the further subanalysis, a weak relationship between the highest group of non HDL (≥190 mg/dL) and the presence of CP was also noted (odds ratio, 1.33; 95% CI, 1.01-1.76; P = 0.04). Further, high non-HDL was associated with increasing numbers of segments with NCP (β coefficient, 0.043; 95% CI, 0.021-0.065; P < 0.001) but not segments with PCP or CP.

CONCLUSION

NCP presence and extent are associated with high non-HDL. These results suggest a relationship between lipid profile and plaque composition.

Matrix metalloproteinase-9 (MMP-9) and myeloperoxidase (MPO) levels in patients with nonobstructive coronary artery disease detected by coronary computed tomographic angiography

RATIONALE AND OBJECTIVES

The aim of this study was to evaluate whether matrix metalloproteinase-9 (MMP-9) and myeloperoxidase (MPO) are elevated in patients with nonobstructive coronary artery disease.

MATERIALS AND METHODS

Eighty-four patients with nonobstructive coronary artery disease (group A) and 90 patients with no coronary plaques (group B) were enrolled. MMP-9 and MPO levels were compared between the two groups. The relationships between these biomarkers and Framingham risk score were analyzed. Receiver-operating characteristic curves were used to evaluate the ability of these biomarkers to predict the presence of coronary artery plaques.

RESULTS

The MMP-9 and MPO values in group A were significantly higher than in group B (P < .001). The levels of MMP-9 and MPO showed significant correlations with Framingham risk score (r = 0.796, P < .001, and r = 0.409, P < .001, respectively). The areas under the receiver-operating characteristic curves for MMP-9 and MPO were 0.80 (95% confidence interval, 0.74-0.87) and 0.74 (95% confidence interval, 0.66-0.81), respectively.

CONCLUSIONS

Levels of MMP-9 and MPO are positively correlated with Framingham risk score. Additionally, in patients with nonobstructive coronary artery disease, elevated levels of MMP-9 and MPO may identify patients at risk for future myocardial infarction or sudden cardiac death.

Characteristics of carotid atherosclerotic plaques of chronic lipid apheresis patients as assessed by in vivo high-resolution CMR--a comparative analysis

BACKGROUND

Components of carotid atherosclerotic plaques can reliably be identified and quantified using high resolution in vivo 3-Tesla CMR. It is suspected that lipid apheresis therapy in addition to lowering serum lipid levels also has an influence on development and progression of atherosclerotic plaques. The purpose of this study was to evaluate the influence of chronic lipid apheresis (LA) on the composition of atherosclerotic carotid plaques.

METHODS

32 arteries of 16 patients during chronic LA-therapy with carotid plaques and stenosis of 1-80% were matched according to degree of stenosis with 32 patients, who had recently suffered an ischemic stroke. Of these patients only the asymptomatic carotid artery was analyzed. All patients underwent black-blood 3 T CMR of the carotids using parallel imaging and dedicated surface coils. Cardiovascular risk factors were recorded. Morphology and composition of carotid plaques were evaluated. For statistical evaluation Fisher's Exact and unpaired t-test were used. A p-value <0.05 was considered statistically significant.

RESULTS

Patients in the LA-group were younger (63.5 vs. 73.9. years, p<0.05), had a higher prevalence of hypercholesterolemia and of established coronary heart disease in patients and in first-degree relatives (p<0.05, respectively). LA-patients had smaller maximum wall areas (49.7 vs. 59.6mm2, p<0.05), showed lower prevalence of lipid cores (28.1% vs. 56.3%, p<0.05) and the lipid content was smaller than in the control group (5.0 vs. 11.6%, p<0.05). Minimum lumen areas and maximum total vessel areas did not differ significantly between both groups.

CONCLUSION

Results of this study suggest that, despite a severer risk profile for cardiovascular complications in LA-patients, chronic LA is associated with significantly lower lipid content in carotid plaques compared to plaques of patients without LA with similar degrees of stenosis, which is characteristic of clinically stable plaques.

Statins use and coronary artery plaque composition: results from the International Multicenter CONFIRM Registry

OBJECTIVE

The effect of statins on coronary artery plaque features beyond stenosis severity is not known. Coronary CT angiography (CCTA) is a novel non-invasive method that permits direct visualization of coronary atherosclerotic features, including plaque composition. We evaluated the association of statin use to coronary plaque composition type in patients without known coronary artery disease (CAD) undergoing CCTA.

METHODS

From consecutive individuals, we identified 6673 individuals (2413 on statin therapy and 4260 not on statin therapy) with no known CAD and available statin use status. We studied the relationship between statin use and the presence and extent of specific plaque composition types, which was graded as non-calcified (NCP), mixed (MP), or calcified (CP) plaque.

RESULTS

The mean age was 59 ± 11 (55% male). Compared to the individuals not taking statins, those taking statins had higher prevalence of risk factors and obstructive CAD. In multivariable analyses, statin use was associated with increased the presence of MP [odds ratio (OR) 1.46, 95% confidence interval (CI) 1.27-1.68), p < 0.001] and CP (OR 1.54, 95% CI 1.36-1.74, p < 0.001), but not NCP (OR 1.11, 95% CI 0.96-1.29, p = 0.1). Further, in multivariable analyses, statin use was associated with increasing numbers of coronary segments possessing MP (OR 1.52, 95% CI 1.34-1.73, p < 0.001) and CP (OR 1.52, 95% CI 1.36-1.70, p < 0.001), but not coronary segments with NCP (OR 1.09, 95% CI 0.94-1.25, p = 0.2).

CONCLUSION

Statin use is associated with an increased prevalence and extent of coronary plaques possessing calcium. The longitudinal effect of statins on coronary plaque composition warrants further investigation.

Association between renal dysfunction and the mixed plaque of coronary artery on computed tomographic angiography

Coronary artery plaque is related to development of coronary artery disease (CAD), and chronic kidney disease is associated with CAD. However, the association of renal dysfunction (RD) with coronary artery plaque characteristics has not been fully elucidated. We evaluated the association between RD and coronary artery plaque characteristics in patients with suspected CAD, who underwent multislice computed tomographic angiography (CTA). A total of 918 patients were classified into 4 groups: group with no plaque (NP) (48.9%), group with calcified plaque (CP) (16.0%), group with noncalcified plaque (NCP) (22.4%), and group with mixed plaque (MP) (12.7%). NCP is considered as rupture-prone soft plaque, and CP as more stable lesion. The mean of estimated glomerular filtration rate (eGFR) was 82.5 ± 15.4 mL/min/1.73 m(2), and the prevalence of RD (defined as eGFR < 60 mL/min/1.73 m(2)) was 6.3%. The prevalence of RD was 3.3% in the NP group, 10.2% in the CP group, 5.3% in the NCP group, and 14.5% in the MP group (P < 0.001 by ANOVA tests). The adjusted odds ratio for RD was 3.38 (95% confidence interval, 1.27-9.04) for the MP group, compared with the NP group. The presence of RD showed an independent association with the MP counts (r = 0.155, P < 0.001); however, there was no association between RD and other plaque characteristics. In conclusion, RD is associated with MP rather than CP or NCP, compared with NP, which may reflect one of the developmental processes of CAD in patients with RD.

Comparison of atherosclerotic plaque by computed tomography angiography in patients with and without diabetes mellitus and with known or suspected coronary artery disease

The aim of this study was to compare coronary artery plaque burden, composition, distribution, and the degree of coronary artery stenosis in diabetic and nondiabetic patients with known or suspected coronary artery disease (CAD). The study group consisted of 594 patients with known or suspected CAD, including 122 diabetics, who underwent multidetector computed tomographic coronary angiography and traditional invasive coronary artery angiography. Coronary artery calcium scores were compared in different age subgroups. Noncalcified plaque, calcified plaque, and mixed plaque were analyzed by coronary segment on computed tomographic coronary angiography, as well as the degree of coronary stenosis on coronary artery angiography. Obstructive vessels were compared between the 2 groups. Total coronary artery calcium score was higher in patients with diabetes compared to those without (378.4 ± 613.0 vs 226.0 ± 408.4, p = 0.003). The percentage of patients with coronary artery calcium scores >400 among diabetics (22.1%) was higher than among nondiabetics (14.2%) (p = 0.032). Diabetics had a higher percentage of coronary segments with noncalcified plaque, calcified plaque, and mixed plaque than nondiabetics (35.3% vs 26.2%, p <0.001; 17.5% vs 11.6%, p = 0.017; and 9.8% vs 7.9%, p = 0.008). More diabetics had multivessel obstructive disease compared to nondiabetics (p <0.05). With longer duration of diabetes mellitus, the stenosed segments of coronary arteries increased accordingly. In conclusion, diabetics have more atherosclerotic plaque burden and more severe coronary atherosclerosis than nondiabetics. Most obstructive lesions were caused by mixed plaques in diabetics and nondiabetics.