title: 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.
abstract: 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.
authors: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
authors: Naoko
authors: N
authors: Takaoka
authors: Kenichi
authors: K
authors: Tsujita
authors: Koichi
authors: K
authors: Kaikita
authors: Seiji
authors: S
authors: Hokimoto
authors: Kenshi
authors: K
authors: Yamanaga
authors: Naohiro
authors: N
authors: Komura
authors: Tadasuke
authors: T
authors: Chitose
authors: Takamichi
authors: T
authors: Ono
authors: Michio
authors: M
authors: Mizobe
authors: Eiji
authors: E
authors: Horio
authors: Koji
authors: K
authors: Sato
authors: Naoki
authors: N
authors: Nakayama
authors: Michiyo
authors: M
authors: Saito
authors: Satomi
authors: S
authors: Iwashita
authors: Sunao
authors: S
authors: Kojima
authors: Shinji
authors: S
authors: Tayama
authors: Seigo
authors: S
authors: Sugiyama
authors: Sunao
authors: S
authors: Nakamura
authors: Hisao
authors: H
authors: Ogawa
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000453:epidemiology; D000368:Aged; D000369:Aged, 80 and over; D060050:Angina, Stable / Q000000981:diagnostic imaging / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood*; D015897:Comorbidity; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D050171:Dyslipidemias / Q000097:blood* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012307:Risk Factors; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL
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