Background: Cardiovascular risk factors have an impact on coronary atherosclerosis evolution. However, there is only limited information about the relationship between risk and atherosclerotic plaque as measured invasively by Intravascular Ultrasound Radiofrequency (IVUS-RF) analysis. The Aim of this study was to assess the impact of cardiovascular risk factors not only on overall coronary plaque volume but on coronary plaque composition.
Methods: 990 patients from 42 centers were enrolled in the prospective, multicenter, non randomized, global VH-IVUS registry. Coronary lesions were measured by conventional and IVUS-VH parameters using 20MHz Intravascular Ultrasound catheter. The four IVUS-VH plaque components (Dense Calcium-DC, Necrotic Core-NC, Fibrous tissue-F, Fibro Fatty-FF) were analyzed in every recorded frame. The results were expressed as mean cross-sectional areas, and percentage of total plaque volume. Risk factor assessment included correlation with family history of myocardial infarction, past or current smoking, diabetes mellitus, hypertension, and laboratory measurements.
Results: Patients with diabetes have an increased relative amount of NC (6.47±0.28% vs. 5.86±0.14%, p=0.037) and DC (4.58±0.27% vs. 3.90±0.14%, p=0.017), Patients with hypertension have an increased relative amount of FF, DC (4.35±0.16% vs. 3.57±0.17%, p=0.02) and NC (6.24±0.17% vs. 5.60±0.19%, p=0.01). Compared with patients with LDL cholesterol 160 mg/dl had higher plaque volume (342.1±26.2mm
3
vs. 318.6±10.7mm
3
). Linear Regression Analysis showed a correlation between the level of HDL and F (r=−0.149, p<0.01), FF (r=−0 –106, p< 0.01), and NC (r=−0.90, p<0.05). The level of LDL correlated with F (r = 0.110, p < 0.01). Patients with prior MI have an increased percentage of F (30.03±0.59 % vs. 28.20±0.37 %, p<0.009). Smoking had no relevant effect on plaque composition.
Conclusion: IVUS-RF analysis detects marked differences in coronary plaque depending on the risk factor profile with particular focus on lipid levels. Patients with greater amounts of necrotic core were associated with hypertension, myocardial infarction, and low HDL. This may have implications for prognosis and systemic treatment of patients with coronary artery disease.
Relationship Between Cardiovascular Risk Factors and Atherosclerotic Disease Burden Measured by Intravascular Ultrasound
