Lipid profile associated with coronary plaque regression in patients with acute coronary syndrome: Subanalysis of PRECISE-IVUS trial.
Although dual low-density lipoprotein cholesterol (LDL-C)-lowering therapy (DLLT) with statin-ezetimibe combination showed clinical benefit in patients with acute coronary syndrome (ACS) confirming "the lower, the better," the underlying mechanisms of DLLT are still unknown.



PRECISE-IVUS trial evaluated the effects of DLLT on IVUS-derived coronary atherosclerosis and lipid profile, compared with atorvastatin monotherapy, quantifying the coronary plaque response in 100 ACS patients. We explored the potential predictors of plaque regression.



Lower total cholesterol, LDL-C, triglyceride, remnant-like particles cholesterol, and stronger reduction of small dense LDL-C and cholesterol absorption markers were observed in patients with plaque regression compared to those with progression. Multivariate analysis revealed that achieved LDL-C was the strongest predictor for coronary plaque regression (95% CI: 0.944-1.000, p = 0.05), followed by age (95% CI: 0.994-1.096, p = 0.09).



Incremental LDL-C lowering by DLLT was associated with stronger coronary plaque regression, reconfirming that lowering LDL-C to levels below previous targets provided additional clinical benefit.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: tsujita@kumamoto-u.ac.jp.
Kenichi
K
Tsujita
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Kenshi
K
Yamanaga
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Naohiro
N
Komura
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Kenji
K
Sakamoto
Jinnouchi Hospital, Kumamoto, Japan.
Seigo
S
Sugiyama
Division of Cardiology, Kumamoto Central Hospital, Kumamoto, Japan.
Hitoshi
H
Sumida
Department of Cardiovascular Medicine, Fukuoka Tokushukai Medical Center, Kasuga, Japan.
Hideki
H
Shimomura
Division of Cardiology, Social Insurance Omuta Tenryo Hospital, Omuta, Japan.
Takuro
T
Yamashita
Division of Cardiology, Health Insurance Hitoyoshi General Hospital, Hitoyoshi, Japan.
Hideki
H
Oka
Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan.
Koichi
K
Nakao
Interventional Cardiology Unit, New Tokyo Hospital, Matsudo, Japan.
Sunao
S
Nakamura
Division of Coronary Artery Disease, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Masaharu
M
Ishihara
Department of Community Medicine, Kumamoto University, Kumamoto, Japan.
Kunihiko
K
Matsui
Division of Cardiology, Amakusa Medical Center, Amakusa, Japan.
Naritsugu
N
Sakaino
Division of Cardiology, Shin-Beppu Hospital, Beppu, Japan.
Natsuki
N
Nakamura
Division of Cardiology, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan.
Nobuyasu
N
Yamamoto
Division of Cardiology, Health Insurance Kumamoto General Hospital, Yatsushiro, Japan.
Shunichi
S
Koide
Division of Cardiology, Japan Labor Health and Welfare Organization Kumamoto Rosai Hospital, Yatsushiro, Japan.
Toshiyuki
T
Matsumura
National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan.
Kazuteru
K
Fujimoto
Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan.
Ryusuke
R
Tsunoda
Division of Cardiology, Kumamoto City Hospital, Kumamoto, Japan.
Yasuhiro
Y
Morikami
Division of Cardiology, Social Insurance Omuta Tenryo Hospital, Omuta, Japan.
Koushi
K
Matsuyama
Division of Cardiology, Kumamoto Central Hospital, Kumamoto, Japan.
Shuichi
S
Oshima
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Koichi
K
Kaikita
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Seiji
S
Hokimoto
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
Hisao
H
Ogawa
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000628:therapy*; D000368:Aged; D000069059:Atorvastatin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002784:Cholesterol / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000628:therapy*; D018450:Disease Progression; D000069438:Ezetimibe / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000188:drug therapy; D011446:Prospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D002784:Cholesterol; D000069059:Atorvastatin; D000069438:Ezetimibe
Ezetimibe; Intravascular ultrasound; Lipoprotein; Plaque; Statin