title: Impact of cholesterol metabolism on coronary plaque vulnerability of target vessels: a combined analysis of virtual histology intravascular ultrasound and optical coherence tomography.
abstract: OBJECTIVE
  The aim of this study was to evaluate the relationship between cholesterol metabolism and coronary plaque vulnerability.
  
  
  BACKGROUND
  Cholesterol homeostasis, defined as the balance between absorption and synthesis, influences the progression of coronary atherosclerosis.
  
  
  METHODS
  Consecutive stable angina pectoris patients (N = 80) not receiving any lipid-lowering therapy were divided into 2 groups based on the presence of in vivo thin cap fibroatheroma (TCFA) in de novo target vessels assessed by the combined use of virtual histology intravascular ultrasound and optical coherence tomography.
  
  
  RESULTS
  Patients with in vivo TCFA (n = 42) showed a higher campesterol-to-lathosterol ratio (3.36 [interquartile range, 2.10 to 4.26] vs. 1.50 [1.20 to 2.50], p < 0.0001). The campesterol-to-lathosterol ratio, low-density lipoprotein (LDL) cholesterol, and high-sensitivity C-reactive protein (hsCRP) were positively correlated with the percentage of necrotic core volume (r = 0.520, p < 0.0001; r = 0.520, p < 0.0001; and r = 0.539, p < 0.0001, respectively) and negatively correlated with thinnest fibrous cap thickness (r = -0.566, p < 0.0001; r = -0.530, p < 0.0001; and r = -0.358, p = 0.007, respectively) . The independent predictors of the incidence of TCFA were the campesterol-to-lathosterol ratio (odds ratio: 3.989, 95% confidence interval: 1.688 to 9.428; p = 0.002), LDL cholesterol (odds ratio: 1.425, 95% confidence interval: 1.023 to 1.985; p = 0.03), hsCRP (odds ratio: 1.025, 95% confidence interval: 1.003 to 1.047; p = 0.02), and the percentage of necrotic core volume (odds ratio:1.084, 95% confidence interval: 1.012 to 1.161; p = 0.02).
  
  
  CONCLUSIONS
  Enhanced absorption and reduced synthesis of cholesterol may be related to coronary plaque vulnerability.
authors.affiliation: Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan. yuyatomoya@gmail.com
authors.forename: Kenya
authors.initials: K
authors.lastname: Nasu
authors.forename: Mitsuyasu
authors.initials: M
authors.lastname: Terashima
authors.forename: Maoto
authors.initials: M
authors.lastname: Habara
authors.forename: Euihong
authors.initials: E
authors.lastname: Ko
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ito
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yokota
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ishizuka
authors.forename: Tairo
authors.initials: T
authors.lastname: Kurita
authors.forename: Masashi
authors.initials: M
authors.lastname: Kimura
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Asakura
authors.forename: Etsuo
authors.initials: E
authors.lastname: Tsuchikane
authors.forename: Osamu
authors.initials: O
authors.lastname: Katoh
authors.forename: Takahiko
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000097:blood / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000031:analogs & derivatives / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D018450:Disease Progression; D005260:Female; D005355:Fibrosis; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D016017:Odds Ratio; D010840:Phytosterols / Q000097:blood; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012422:Rupture, Spontaneous; D041623:Tomography, Optical Coherence; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D010840:Phytosterols; C021273:campesterol; C001521:lathosterol; D002097:C-Reactive Protein; D002784:Cholesterol
keywords: CAD; IVUS; LDL; OCT; TCFA; VH; Virtual Histology; cholesterol metabolism; coronary artery disease; high-sensitivity C-reactive protein; hsCRP; intravascular ultrasound; low-density lipoprotein; optical coherence tomography; thin cap fibroatheroma; virtual histology