High-intensity Statin Treatment Is Associated with Reduced Plaque Structural Stress and Remodelling of Artery Geometry and Plaque Architecture

Abstract Aims Plaque structural stress (PSS) is a major cause of atherosclerotic plaque rupture and major adverse cardiovascular events (MACE). We examined the predictors of changes in peak and mean PSS (ΔPSSpeak, ΔPSSmean) in three studies of patients receiving either standard medical or high-intensity statin (HIS) treatment. Methods and results We examined changes in PSS, plaque size and composition between 7,348 co-registered baseline and follow-up virtual-histology intravascular ultrasound images in patients receiving standard medical treatment (controls, n = 18) or HIS (atorvastatin 80mg, n = 20, or rosuvastatin 40mg, n = 22). The relationship between changes in PSSpeak and plaque burden (PB) differed significantly between HIS and control groups (p < 0.001). Notably, PSSpeak increased significantly in control lesions with PB > 60% (p = 0.04), but not with HIS treatment. However, ΔPSSpeak correlated poorly with changes in lumen and plaque area or PB, plaque composition or lipid lowering. In contrast, ΔPSSpeak correlated significantly with changes in lumen curvature, irregularity and roughness (p < 0.05), all of which were reduced in HIS patients. ΔPSSmean correlated with changes in lumen area, PA, PB, and circumferential calcification, and was unchanged with either treatment. Conclusion Our observational study shows that PSSpeak changes over time were associated with baseline disease severity and treatment. The PSSpeak increase seen in advanced lesions with standard treatment was associated with remodelling artery geometry and plaque architecture, but this was not seen after HIS treatment. Smoothing plaques by reducing plaque/lumen roughness, irregularity and curvature represent a novel mechanism whereby high-intensity statins may reduce PSS, and thus may protect against plaque rupture and MACE.

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Abstract 10426: One Year Impact of the 2013 Cholesterol Guidelines on Patterns of Lipid Lowering Treatment

Circulation ◽

10.1161/circ.132.suppl_3.10426 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Josephine N Tran ◽

Tzu Chun Kao ◽

Toros Caglar ◽

Karen M Stockl ◽

Heidi C Lew ◽

...

Keyword(s):

Statin Therapy ◽

High Intensity ◽

Arterial Disease ◽

Statin Treatment ◽

Lipid Lowering ◽

High Dose ◽

Atherosclerotic Cardiovascular Disease ◽

Patients With Diabetes ◽

Cholesterol Guidelines ◽

One Year

Background: In 2013, national organizations issued new cholesterol guidelines to emphasize evidence-based treatment with moderate- to high-dose statins for patients at high risk for atherosclerotic cardiovascular disease (ASCVD), which includes coronary heart disease, stroke, and peripheral arterial disease. Whether these new guidelines have influenced patterns of treatment one year after their dissemination is unknown. Methods: Using pharmacy and medical claims from a large U.S. health insurance organization, we identified 610,535 adult patients with ASCVD (n=301,440) or diabetes mellitus (n=309,095) and examined statin treatment rates before and one year after the new cholesterol guidelines. Among patients receiving statins post-guidelines, we also evaluated whether patients were treated with guideline-recommended intensity of statin therapy. A standardized difference (SD) of at least 10% was required to declare the effect size meaningful. Results: Overall, there was no change in statin treatment rates for patients with ASCVD (48.0% before guidelines vs. 47.3% after, SD [1.4]) or diabetes (50% vs. 51.5% after, SD [2.4]). Statin initiation rates among patients not on statins pre-guidelines were 10.1% in patients with ASCVD and 14.3% in patients with diabetes, and these gains were offset by 13.0% and 12.2% statin discontinuation rates among ASCVD and diabetes patients, respectively. Among patients taking statins one year post-guidelines, 80% of patients with ASCVD and < 75 years of age were not on guideline-recommended high-intensity statin therapy, whereas >75% of patients with ASCVD and >75 years of age or patients with diabetes were on moderate- or high-intensity statin treatment. Conclusion: One year after dissemination of the new 2013 cholesterol guidelines, overall treatment rates with statins among patients with ASCVD and diabetes have not changed appreciably, and many patients remain either untreated or under-treated. Character Count: 1683

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4115Effect of alirocumab on recurrent cardiovascular events after acute coronary syndrome, according to the intensity of background statin treatment

European Heart Journal ◽

10.1093/eurheartj/ehz745.0119 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Diaz ◽

Q H Li ◽

D L Bhatt ◽

V A Bittner ◽

M T Baccara-Dinet ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

High Intensity ◽

Cardiovascular Events ◽

Statin Treatment ◽

Moderate Intensity ◽

Major Adverse Cardiovascular Events ◽

P Value ◽

Coronary Syndrome ◽

To Receive ◽

Statin Use

Abstract Background Statins are a cornerstone of therapy for coronary heart disease. We describe the effects of alirocumab (ALI) in patients (pts) with recent acute coronary syndrome (ACS) and dyslipidaemia per category of statin use. Methods ODYSSEY OUTCOMES compared ALI with placebo (PBO) in 18,924 pts with recent ACS and dyslipidaemia despite high-intensity/maximum tolerated statin (atorvastatin 40–80 mg/d or rosuvastatin 20–40 mg/d). Lower doses could be used if there were symptoms, laboratory abnormalities, or contraindications with higher doses. In cases of documented intolerance to ≥2 statins, pts could qualify on no statin treatment. Pts were randomized to ALI (75 mg SC Q2W, with possible uptitration to 150 mg Q2W) or PBO. Median follow-up was 2.8 years. Primary endpoint was major adverse cardiovascular events (MACE: CHD death, non-fatal MI, ischaemic stroke, or unstable angina requiring hospitalization). Pts were categorized by statin therapy at baseline: high intensity (88.8%), low or moderate intensity (8.7%), or no statin use (2.4%). In each category we determined the relative (hazard ratio [HR]) and absolute risk reductions (ARR) for MACE with ALI. Results Overall, ALI reduced MACE (HR 0.85, 95% CI 0.78–0.93; P<0.001). HRs were consistent across statin categories (Table). Baseline LDL-C increased across high-intensity, low/moderate-intensity, and no statin categories. Correspondingly, there was a gradient of the risk of MACE in the PBO group across these categories (10.8%, 10.7%, and 26%). With ALI treatment, the mean reduction in LDL-C from baseline to Month 4 increased across the 3 statin categories and correspondingly the ARRs for MACE were 1.3%, 3.2%, and 8.0% (P interaction <.001). LDL-C values and MACE events All patients High-intensity statin Low-/moderate-intensity statin No statin Interaction P-value N=18,924 (100%) N=16,811 (88.8%) N=1653 (8.7%) N=460 (2.4%) (treatment x statin category) PBO (N=9462) ALI (N=9462) PBO (N=8431) ALI (N=8380) PBO (N=804) ALI (N=849) PBO (N=227) ALI (N=233) LDL-C at baseline, mmol/L, mean (SE)* 2.39 (0.01) 2.39 (0.01) 2.35 (0.01) 2.35 (0.01) 2.41 (0.03) 2.43 (0.03) 3.76 (0.08) 3.82 (0.08) Change in LDL-C from baseline to Month 4, mmol/L, mean (SE) 0.03 (0.01) −1.4 (0.01) 0.03 (0.01) −1.37 (0.01) 0.01 (0.02) −1.47 (0.02) −0.004 (0.06) −2.27 (0.06) <0.001 MACE, n (%)* 1052 (11.1) 903 (9.5) 907 (10.8) 797 (9.5) 86 (10.7) 64 (7.5) 59 (26.0) 42 (18.0) HR (95% CI) 0.85 (0.78−0.93) 0.88 (0.80−0.96) 0.69 (0.50−0.95) 0.65 (0.43−0.96) 0.14 ARR (%) (95% CI) 1.6 (0.7−2.4) 1.3 (0.3−2.2) 3.2 (0.4−5.9) 8.0 (0.4−15.5) <0.001 *P<0.001 for difference among statin categories. Conclusions In ODYSSEY OUTCOMES, patients unable to receive high-intensity statin treatment showed greater ARRs with ALI, consistent with higher baseline LDL-C concentration and greater absolute LDL-C reduction. Patients unable to receive high-intensity statin treatment are an important group to consider for treatment with ALI after ACS. Acknowledgement/Funding Funded by Sanofi and Regeneron Pharmaceuticals

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Improving statin treatment strategies to reduce LDL-cholesterol: factors associated with targets’ attainment in subjects with and without type 2 diabetes

Cardiovascular Diabetology ◽

10.1186/s12933-021-01338-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Mario Luca Morieri ◽

Valentina Perrone ◽

Chiara Veronesi ◽

Luca Degli Esposti ◽

Margherita Andretta ◽

...

Keyword(s):

Secondary Prevention ◽

High Intensity ◽

Ldl Cholesterol ◽

Treatment Strategies ◽

Hdl Cholesterol ◽

Statin Treatment ◽

Lipid Lowering ◽

Treatment Intensity ◽

Cross Sectional ◽

Cholesterol Levels

Abstract Background This cross-sectional study aimed to identify actionable factors to improve LDL-cholesterol target achievement and overcome underuse of lipid-lowering treatments in high- or very-high-cardiovascular risk patients. Methods We evaluated healthcare records of 934,332 subjects from North-Italy, including subjects with available lipid profile and being on statin treatments up to December 2018. A 6-month-period defined adherence with proportion-of-days-covered ≥ 80%. Treatment was classified as high-intensity-statin (HIS) + ezetimibe, HIS-alone, non-HIS (NHIS) + ezetimibe or NHIS alone. Results We included 27,374 subjects without and 10,459 with diabetes. Among these, 30% and 36% were on secondary prevention, respectively. Adherence was high (78–100%) and increased with treatment intensity and in secondary prevention. Treatment intensity increased in secondary prevention, but only 42% were on HIS. 2019-guidelines LDL-cholesterol targets were achieved in few patients and more often among those with diabetes (7.4% vs. 10.7%, p < 0.001). Patients in secondary prevention had mean LDL-cholesterol levels aligned slightly above 70 mg/dl (range between 68 and 73 mg/dl and between 73 and 85 mg/dl in patients with and without diabetes, respectively). Moreover, the differences in mean LDL-cholesterol levels observed across patients using treatments with well-stablished different LDL-lowering effect were null or much smaller than expected (HIS vs. NHIS from − 3 to − 11%, p < 0.001, HIS + ezetimibe vs. HIS—from − 4 to + 5% n.s.). These findings, given the observational design of the study, might suggest that a “treat to absolute LDL-cholesterol levels” approach (e.g., targeting LDLc of 70 mg/dl) was mainly used by physicians rather than an approach to also achieve the recommended 50% reduction in LDL-cholesterol levels. Our analyses suggested that female sex, younger age, higher HDL-c, and elevated triglycerides are those factors delaying prescription of statin treatments, both in patients with and without diabetes and in those on secondary prevention. Conclusions Among patients on statin treatment and high adherence, only a small proportion of patients achieved LDL-cholesterol targets. Late initiation of high-intensity treatments, particularly among those with misperceived low-risk (e.g., female subjects or those with high HDL-cholesterol), appears as pivotal factors needing to be modified to improve CVD prevention.

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Efficacy and Safety of Evolocumab in Reducing Low Density Lipoprotein Cholesterol Levels in Chinese Patients with Non-ST-segment Elevation Acute Coronary Syndrome

Current Vascular Pharmacology ◽

10.2174/1570161118666200616144141 ◽

2020 ◽

Vol 18 ◽

Author(s):

Xiaohan Xu ◽

Meng Chai ◽

Yujing Cheng ◽

Pingan Peng ◽

Xiaoli Liu ◽

...

Keyword(s):

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Statin Treatment ◽

Chinese Patients ◽

Lipid Lowering ◽

Control Group ◽

Lipid Lowering Therapy ◽

St Segment Elevation ◽

Coronary Syndrome ◽

St Segment

Aims: To explore early intensive lipid-lowering therapy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Background: Lowering low-density lipoprotein cholesterol (LDL-C) levels can reduce cardiovascular morbidity and mortality in patients with atherosclerotic cardiovascular disease. Due to many reasons, the need for early intensive lipid-lowering therapy is far from being met in Chinese NSTE-ACS patients at high-risk of recurrent ischaemic events. Objective: To evaluate the feasibility, safety and efficacy of starting evolocumab in hospital to lower LDL-C levels in Chinese patients with NSTE-ACS. Methods: In this prospective cohort study initiated by researchers, 334 consecutive patients with NSTE-ACS who had sub-standard LDL-C levels (LDL-C ≥2.3 mmol/L after regular oral statin treatment for at least 4 weeks; or LDL-C ≥3.2 mmol/L without regular oral statin treatment) were included. Patients who agreed to treatment with evolocumab (140 mg subcutaneously every 2 weeks, initiated in hospital and used for 12 weeks after discharge) were enrolled in the evolocumab group (n=96) and others in the control group (n=238). All enrolled patients received regular statin treatment (atorvastatin 20 mg/day or rosuvastatin 10 mg/day; doses unchanged throughout the study).The primary endpoint was the change in LDL-C levels from baseline to week 12. Results: Most patients (67.1%) had not received regular statin treatment before. In the evolocumab group, LDL-C levels decreased significantly at week 4 and remained stable at week 8 and 12 (all p<0.001). At week 12, the LDL-C percentage change from baseline in the evolocumab group was -79.2±12.7% (from an average of 3.7 to 0.7 mmol/L), while in the control group it was -37.4±15.4% (from an average of 3.3 to 2.0 mmol/L). The mean difference between these 2 groups was -41.8% (95% CI -45.0 to -38.5%; p<0.001). At week 12, the proportions of patients with LDL-C levels <1.8 mmol/L and 1.4 mmol/L in the evolocumab group were significantly higher than in the control group (96.8 vs 36.1%; 90.6 vs 7.1%; both p<0.001). The incidence of adverse events and cardiovascular events was similar in both groups. Conclusions: In this prospective cohort study we evaluated the early initiation of evolocumab in NSTE-ACS patients in China. Evolocumab combined with statins significantly lowered LDL-C levels and increased the probability of achieving recommended LDL-C levels, with satisfactory safety and well tolerance.

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How many CCS- and ACS-patients might reach the newly recommended LDL-C-target <55mg/dl in clinical practice if guidelines were applied – an estimate from the DYSIS II study population

European Heart Journal ◽

10.1093/ehjci/ehaa946.1445 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A.K Gitt ◽

M Horack ◽

D Lautsch ◽

R Zahn ◽

J Ferrieres

Keyword(s):

Clinical Practice ◽

Real Life ◽

Statin Treatment ◽

Lipid Lowering ◽

High Risk Population ◽

High Dose ◽

Funding Source ◽

Pcsk9 Inhibitors ◽

Target Values ◽

Coronary Syndromes

Abstract Background The 2019 ESC guidelines for the management of dyslipidemia even further lowered the LDL-C-target values for the very high-risk population from <70mg/dl to <55mg/dl. Population based studies already had shown that the previous target was difficult to reach. It is yet unclear how many patients in clinical practice might be treated to the new target. Methods The Dyslipidemia International Study (DYSIS II) prospectively collected data of patients with chronic coronary syndromes (CCS) and acute coronary syndromes (ACS) (all on statins) in 18 countries in Europe, the Middle East, South- and East Asia to document patient characteristics, medication and a current lipid profile from 2012 to 2014 under real life conditions in physicians' offices and hospitals. We took these real-life lipid profiles and data on the kind/dose of used statins to estimate how treatment escalation such as changing statin treatment to a high dose (atorvastatin ≥40mg / rosuvastatin≥20mg), adding ezetimibe and adding a PCSK9-inhibitor might help to bring LDL-C-levels to the recommended <55mg/dl target. Results A total of 7,865 patients were enrolled into DYSIS II, 6,794 had CCS and 1,071 ACS. Under the documented statin treatment in DYSIS only 12.7% of patients reached an LDL-C <55mg/dl. Putting all patients on high dose statins in combination with ezetimibe, 64.1% would reach the target. If PCSK9-inhibitors would be used in the remaining patients not at goal a total of 94.0% would match the goal. Conclusion Our analysis indicates that in real life practice the use available lipid-lowering medications would substantially increase the percentage of CCS- and ACS-patients reaching the newly recommended 2019 ESC guideline LDL-C-target of <55 mg/dl from less than 20% to more than 90% of the population. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD

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Coronary lesion complexity in patients with heterozygous familial hypercholesterolemia hospitalized for acute myocardial infarction: data from the RICO survey

Lipids in Health and Disease ◽

10.1186/s12944-021-01467-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Hermann Yao ◽

Michel Farnier ◽

Laura Tribouillard ◽

Frédéric Chague ◽

Philippe Brunel ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Ldl Cholesterol ◽

Statin Treatment ◽

Lipid Lowering ◽

Syntax Score ◽

Lipid Lowering Therapy ◽

Lipid Clinic ◽

Acute Mi ◽

Artery Disease

Abstract Background Although patients with familial heterozygous hypercholesterolemia (FH) have a high risk of early myocardial infarction (MI), the coronary artery disease (CAD) burden in FH patients with acute MI remains to be investigated. Methods The data for all consecutive patients hospitalized in 2012–2019 for an acute MI and who underwent coronary angiography were collected from a multicenter database (RICO database). FH (n = 120) was diagnosed using Dutch Lipid Clinic Network criteria (score ≥ 6). We compared the angiographic features of MI patients with and without FH (score 0–2) (n = 234) after matching for age, sex, and diabetes (1:2). Results Although LDL-cholesterol was high (208 [174–239] mg/dl), less than half of FH patients had chronic statin treatment. When compared with non-FH patients, FH increased the extent of CAD (as assessed by SYNTAX score; P = 0.005), and was associated with more frequent multivessel disease (P = 0.004), multiple complex lesions (P = 0.022) and significant stenosis location on left circumflex and right coronary arteries. Moreover, FH patients had more multiple lesions, with an increased rate of bifurcation lesions or calcifications (P = 0.021 and P = 0.036, respectively). In multivariate analysis, LDL-cholesterol levels (OR 1.948; 95% CI 1.090–3.480, P = 0.024) remained an independent estimator of anatomical complexity of coronary lesions, in addition to age (OR 1.035; 95% CI 1.014–1.057, P = 0.001). Conclusions FH patients with acute MI had more severe CAD, characterized by complex anatomical features that are mainly dependent on the LDL-cholesterol burden. Our findings reinforce the need for more aggressive preventive strategies in these high-risk patients, and for intensive lipid-lowering therapy as secondary prevention.

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Circulating levels of proprotein convertase subtilisin/kexin type 9 (PCSK9) are associated with monocyte subsets in patients with stable coronary artery disease

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.278 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

KA Krychtiuk ◽

M Lenz ◽

P Hohensinner ◽

K Distelmaier ◽

L Schrutka ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Statin Treatment ◽

Lipid Lowering ◽

Monocyte Subsets ◽

Proprotein Convertase ◽

Artery Disease ◽

Circulating Levels ◽

Classical Monocytes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FWF Background and aims Proprotein convertase subtilisin/kexin type-9 (PCSK9) is an enzyme promoting the degradation of low-density lipoprotein receptors (LDL-R) in hepatocytes. Inhibition of PCSK9 has emerged as a novel target for lipid-lowering therapy. Monocytes are crucially involved in the pathogenesis of atherosclerosis and can be divided into three subsets. The aim of this study was to examine whether circulating levels of PCSK9 are associated with monocyte subsets. Methods We included 69 patients with stable coronary artery disease. PCSK9 levels were measured and monocyte subsets were assessed by flow cytometry and divided into classical monocytes (CD14++CD16-; CM), intermediate monocytes (CD14++CD16+; IM) and non-classical monocytes (CD14 + CD16++; NCM). Results Mean age was 64 years and 80% of patients were male. Patients on statin treatment (n = 55) showed higher PCSK9-levels (245.4 (206.0-305.5) ng/mL) as opposed to those without statin treatment (186.1 (162.3-275.4) ng/mL; p = 0.05). In patients on statin treatment, CM correlated with circulating PCSK9 levels (R = 0.29; p = 0.04), while NCM showed an inverse correlation with PCSK9 levels (R=-0.33; p = 0.02). Patients with PCSK9 levels above the median showed a significantly higher proportion of CM as compared to patients with PCSK-9 below the median (83.5 IQR 79.2-86.7 vs. 80.4, IQR 76.5-85.2%; p = 0.05). Conversely, PCSK9 levels >median were associated with a significantly lower proportion of NCM as compared to those with PCSK9 <median (10.2, IQR 7.3-14.6 vs. 14.3, IQR 10.9-18.7%; p = 0.02). In contrast, IM showed no association with PCSK-9 levels. Conclusions We hereby provide a novel link between PCSK9 regulation, innate immunity and atherosclerotic disease in statin-treated patients.

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Alternative C3 Complement System: Lipids and Atherosclerosis

International Journal of Molecular Sciences ◽

10.3390/ijms22105122 ◽

2021 ◽

Vol 22 (10) ◽

pp. 5122

Author(s):

Maisa Garcia-Arguinzonis ◽

Elisa Diaz-Riera ◽

Esther Peña ◽

Rafael Escate ◽

Oriol Juan-Babot ◽

...

Keyword(s):

Cell Culture ◽

Systems Biology ◽

Complement System ◽

Computed Tomographic Angiography ◽

Lipid Lowering ◽

Plaque Burden ◽

Active Components ◽

Differential Proteomics ◽

Computed Tomographic ◽

Atherosclerotic Process

Familial hypercholesterolemia (FH) is increasingly associated with inflammation, a phenotype that persists despite treatment with lipid lowering therapies. The alternative C3 complement system (C3), as a key inflammatory mediator, seems to be involved in the atherosclerotic process; however, the relationship between C3 and lipids during plaque progression remains unknown. The aim of the study was to investigate by a systems biology approach the role of C3 in relation to lipoprotein levels during atherosclerosis (AT) progression and to gain a better understanding on the effects of C3 products on the phenotype and function of human lipid-loaded vascular smooth muscle cells (VSMCs). By mass spectrometry and differential proteomics, we found the extracellular matrix (ECM) of human aortas to be enriched in active components of the C3 complement system, with a significantly different proteomic signature in AT segments. Thus, C3 products were more abundant in AT-ECM than in macroscopically normal segments. Furthermore, circulating C3 levels were significantly elevated in FH patients with subclinical coronary AT, evidenced by computed tomographic angiography. However, no correlation was identified between circulating C3 levels and the increase in plaque burden, indicating a local regulation of the C3 in AT arteries. In cell culture studies of human VSMCs, we evidenced the expression of C3, C3aR (anaphylatoxin receptor) and the integrin αMβ2 receptor for C3b/iC3b (RT-PCR and Western blot). C3mRNA was up-regulated in lipid-loaded human VSMCs, and C3 protein significantly increased in cell culture supernatants, indicating that the C3 products in the AT-ECM have a local vessel-wall niche. Interestingly, C3a and iC3b (C3 active fragments) have functional effects on VSMCs, significantly reversing the inhibition of VSMC migration induced by aggregated LDL and stimulating cell spreading, organization of F-actin stress fibers and attachment during the adhesion of lipid-loaded human VSMCs. This study, by using a systems biology approach, identified molecular processes involving the C3 complement system in vascular remodeling and in the progression of advanced human atherosclerotic lesions.

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KIF6 gene as a pharmacogenetic marker for lipid-lowering effect in statin treatment

PLoS ONE ◽

10.1371/journal.pone.0205430 ◽

2018 ◽

Vol 13 (10) ◽

pp. e0205430 ◽

Cited By ~ 5

Author(s):

Cristina Ruiz-Iruela ◽

Ariadna Padró-Miquel ◽

Xavier Pintó-Sala ◽

Neus Baena-Díez ◽

Assumpta Caixàs-Pedragós ◽

...

Keyword(s):

Statin Treatment ◽

Lipid Lowering ◽

Lowering Effect ◽

Lipid Lowering Effect

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Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Nonobstructive Coronary Artery Disease

Journal of Diabetes Research ◽

10.1155/2021/5597467 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Yipu Ding ◽

Zinuan Liu ◽

Guanhua Dou ◽

Xia Yang ◽

Xi Wang ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

High Risk ◽

Prognostic Value ◽

Risk Scores ◽

Plaque Burden ◽

Major Adverse Cardiovascular Events ◽

Diabetic Patients ◽

Nonobstructive Coronary Artery Disease ◽

Artery Disease

Background and Objective. Atherosclerotic extent was proved to be associated with adverse cardiac events. Risk scores derived by coronary computed tomography angiography (CCTA) could identify high-risk group among patients with nonobstructive coronary artery disease (CAD), but the ability is still uncertain in the presence of diabetes mellitus (DM). The purpose of this study was to investigate the prognostic value of the atherosclerotic extent shown by CCTA in diabetic patients with nonobstructive CAD. Methods and Results. 813 DM patients (mean age 58.9 ± 9.9 years, 48.1% male) referred for CCTA due to suspected CAD in 2015-2017 were consecutively included. During a median follow-up of 31.77 months, 50 major adverse cardiovascular events (MACEs) (6.15%) were experienced, including 2 cardiovascular deaths, 14 nonfatal myocardial infarctions, 27 unstable anginas requiring hospitalization, and 7 strokes. Three groups were defined based on coronary stenosis combined with Leiden score as normal, nonobstructive Leiden < 5 , and nonobstructive Leiden ≥ 5 . Cox models were used to assess the prognosis of plaque burden within these groups. An incremental incidence of MACE rates was observed. After adjustment for age, gender, and presence of high-risk plaque, the group of Leiden ≥ 5 showed a higher risk than Leiden < 5 (HR: 1.88, 95% CI: 1.03-3.42, p = 0.039 ). Similar results were observed when segment involvement score (SIS) was used for sensitivity analysis. Conclusion. Atherosclerotic extent was associated with the prognosis of DM patients with nonobstructive coronary artery disease, highlighting the importance of better risk stratification and management.

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