title: Plaque vulnerability at non-culprit lesions in obese patients with coronary artery disease: Frequency-domain optical coherence tomography analysis.
abstract: BACKGROUND
  Obesity is associated with adverse atherosclerotic cardiovascular events. While various metabolic abnormalities associated with obesity promote plaque formation, the morphological phenotype of atherosclerotic plaque has not been well characterized in the setting of obesity. Frequency-domain optical coherence tomography (FD-OCT) enables in vivo visualization of plaque microstructures associated with vulnerability. We characterized plaque microstructures in obese patients.
  
  
  METHODS
  FD-OCT imaging was performed in 308 patients with coronary artery disease undergoing percutaneous coronary intervention. Patients were stratified according to the presence or absence of obesity (body mass index > 30 kg/m(2)). Plaques in obese (n = 129) and non-obese (n = 179) patients were compared with regard to clinical characteristics and FD-OCT-derived features of plaque vulnerability.
  
  
  RESULTS
  Obese patients were more likely to be younger (p = 0.01), female (p = 0.01) and have a history of hypertension (p = 0.01). Higher levels of triglyceride (p < 0.0001) and glucose (p = 0.02), whereas a lower level of high-density lipoprotein cholesterol (HDL-C) (p = 0.02) was observed in obese patients. FD-OCT imaging demonstrated thinner fibrous caps (85.3 ± 31.1 vs 110.1 ± 32.4 µm, p = 0.01) and a higher prevalence of thin-cap fibroatheroma (28.8 vs 14.3%, p = 0.01) in obese patients, which remained significant after controlling for differences in clinical characteristics. Achieving a low-density lipoprotein cholesterol (LDL-C) level < 1.8 mmol/l was associated with thicker fibrous caps in obese patients, but only to the level observed in non-obese patients with suboptimal lipid control.
  
  
  CONCLUSIONS
  Obese patients harbor more vulnerable plaques in association with atherogenic risk factors. The limited benefit of lipid control suggests the need to adopt novel anti-atherosclerotic strategies in higher-risk patients.
authors.affiliation: South Australian Health and Medical Research Institute, University of Adelaide, Australia jimmyk67@yahoo.co.jp.
authors.forename: Yu
authors.initials: Y
authors.lastname: Kataoka
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Hammadah
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: Bhanu
authors.initials: B
authors.lastname: Duggal
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: Kiyoko
authors.initials: K
authors.lastname: Uno
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Nissen
authors.affiliation: South Australian Health and Medical Research Institute, University of Adelaide, Australia.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholls
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D003331:Coronary Vessels / Q000378:metabolism / Q000473:pathology*; D005260:Female; D005355:Fibrosis; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D012307:Risk Factors; D041623:Tomography, Optical Coherence
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids
keywords: Obesity; imaging; plaque