Clinical predictors of plaque progression despite very low levels of low-density lipoprotein cholesterol.
OBJECTIVE
The purpose of this study was to characterize the determinants of plaque progression despite achieving very low levels of low-density lipoprotein cholesterol (LDL-C).


BACKGROUND
Despite achieving very low levels of LDL-C, many patients continue to demonstrate disease progression and have clinical events.


METHODS
A total of 3,437 patients with coronary artery disease underwent serial intravascular ultrasound examination in 7 clinical trials. Patients who achieved an on-treatment LDL-C level of <or=70 mg/dl (n = 951) were stratified as progressors (n = 200) and nonprogressors (n = 751) and compared.


RESULTS
Despite achieving LDL-C <or=70 mg/dl, >20% of patients continued to progress. There were no demographic differences between groups. Progressors demonstrated higher baseline levels of glucose (117.1 +/- 42.5 mg/dl vs. 112.1 +/- 40.0 mg/dl, p = 0.02), triglycerides (157.5 mg/dl vs. 133.0 mg/dl, p = 0.004), and a smaller decrease of apolipoprotein B (-25.1 +/- 3.4 mg/dl vs. -27.4 +/- 3.35 mg/dl, p = 0.01) at follow-up. Multivariable analysis revealed that independently associated risk factors of progression in patients with LDL-C <or=70 mg/dl included baseline percent atheroma volume (p = 0.001), presence of diabetes mellitus (p = 0.02), increase in systolic blood pressure (p = 0.001), less increase in high-density lipoprotein cholesterol (p = 0.01), and a smaller decrease in apolipoprotein B levels (p = 0.001), but not changes in C-reactive protein (p = 0.78) or LDL-C (p = 0.84).


CONCLUSIONS
Residual risk factors are associated with the likelihood of disease progression in patients who achieve very low LDL-C levels. In addition, the association between apolipoprotein B and atheroma progression highlights the potential importance of LDL particle concentration in patients with optimal LDL-C control. This finding highlights the need for intensive modification of global risk in patients with coronary artery disease.
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Ozgur
O
Bayturan
Samir
S
Kapadia
Stephen J
SJ
Nicholls
E Murat
EM
Tuzcu
Mingyuan
M
Shao
Kiyoko
K
Uno
Ajai
A
Shreevatsa
Andrea J
AJ
Lavoie
Kathy
K
Wolski
Paul
P
Schoenhagen
Steven E
SE
Nissen
D050197:Atherosclerosis / Q000097:blood / Q000000981:diagnostic imaging*; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000097:blood / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D018084:Ultrasonography, Interventional / Q000379:methods*
D008078:Cholesterol, LDL