Vol 28, No 6 (2021)
Original Article
Published online: 2019-12-23
The influence of high-density lipoprotein cholesterol on maximal lipid core burden indexing thin cap fibrous atheroma lesions as assessed by near infrared spectroscopy
Abstract
Background: Previous studies suggest that higher plasma concentrations of several lipid molecules are associated with higher lipid core burden index (LCBI) near infrared spectroscopy (NIRS) imaging. The aim of this study was to investigate whether an association between plasma lipids depends on plaque morphology (thin cap fibrous atheroma [TCFA] vs. non-TFCA) as measured by near-infrared spectroscopy–intravascular ultrasound (NIRS-IVUS).
Methods: Sixty-four patients retrospectively enrolled were diagnosed with stable coronary artery disease or acute coronary syndrome who underwent NIRS-IVUS imaging. Before percutaneous coronary intervention, blood samples were collected for measurement of serum levels of total cholesterol (TC), lowdensity lipoprotein cholesterol (HDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Patients were divided into two groups based on maxLCBI4mm and IVUS imaging. Those with maxLCBI4mm ≥ 323 were included into TCFA group (n = 35) while others were assigned to the non-TCFA group (n = 29).
Results: Thin cap fibrous atheroma lesions were significantly longer than the non-TCFA lesions (25.66 ± 9.56 vs. 17.03 ± 9.22, p = 0.001). TCFA characterizes greater plaque burden (78.4 [70.9, 82.2] vs. 72.70 [64.77, 76,05]; p = 0.021) and plaque volume (176.1 [110.75, 247.5] vs. 68.1 [55.58, 143.35]; p = 0.000) as compared to non-TCFA. In TCFA suspected lesions, there was no correlation between max-LCBI4mm and LDL levels (r = 0.105, p = 0.549) nor TC levels (r = –0.035, p = 0.844) but a negative correlation was found between HDL-C and maxLCBI4mm (r = –0.453, p = 0.007).
Conclusions: The present study showed that there was no correlation between plasma LDL-C, TC and TG level and the amount of lipids in coronary plaque assessed by NIRS in both TCFA and non-TCFA groups. Only HDL-C correlated with maxLCBI4mm in TCFA lesions.
Keywords: lipid plasma levelsNIRS-IVUS
References
- Wilkins E, Wilson L, Wickramasinghe K, et al. European Cardiovascular Disease Statistics 2017 edition. Eur Hear Network, Brussels. 2017.
- Farb A, Tang AL, Burke AP, et al. Sudden coronary death. Frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction. Circulation. 1995; 92(7): 1701–1709.
- Davies MJ, Richardson PD, Woolf N, et al. Risk of thrombosis in human atherosclerotic plaques: role of extracellular lipid, macrophage, and smooth muscle cell content. Br Heart J. 1993; 69(5): 377–381.
- Kolodgie FD, Burke AP, Farb A, et al. The thin-cap fibroatheroma: a type of vulnerable plaque: the major precursor lesion to acute coronary syndromes. Curr Opin Cardiol. 2001; 16(5): 285–292.
- Virmani R, Kolodgie F, Burke A, et al. Lessons From Sudden Coronary Death. Arter Thromb Biol. 2000; 20(5): 1262–1275.
- Virmani R, Burke A, Willerson J, et al. The pathology of vulnerable plaque. Vulnerable Atherosclerotic Plaque. 2007: 19–36.
- Burke AP, Farb A, Malcom GT, et al. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997; 336(18): 1276–1282.
- Madder RD, Goldstein JA, Madden SP, et al. Detection by near-infrared spectroscopy of large lipid core plaques at culprit sites in patients with acute ST-segment elevation myocardial infarction. JACC Cardiovasc Interv. 2013; 6(8): 838–846.
- Waxman S, Dixon SR, L'Allier P, et al. In vivo validation of a catheter-based near-infrared spectroscopy system for detection of lipid core coronary plaques: initial results of the SPECTACL study. JACC Cardiovasc Imaging. 2009; 2(7): 858–868.
- Roleder T, Kovacic JC, Ali Z, et al. Combined NIRS and IVUS imaging detects vulnerable plaque using a single catheter system: a head-to-head comparison with OCT. EuroIntervention. 2014; 10(3): 303–311.
- Inaba S, Mintz GS, Burke AP, et al. Intravascular ultrasound and near-infrared spectroscopic characterization of thin-cap fibroatheroma. Am J Cardiol. 2017; 119(3): 372–378.
- Silbernagel G, Fauler G, Renner W, et al. The relationships of cholesterol metabolism and plasma plant sterols with the severity of coronary artery disease. J Lipid Res. 2009; 50(2): 334–341.
- Strandberg T, Tilvis R, Pitkala K, et al. Cholesterol and Glucose Metabolism and Recurrent Cardiovascular Events Among the Elderly. J Am Coll Cardiol. 2006; 48(4): 708–714.
- Nasu K, Terashima M, Habara M, et al. Impact of cholesterol metabolism on coronary plaque vulnerability of target vessels: a combined analysis of virtual histology intravascular ultrasound and optical coherence tomography. JACC Cardiovasc Interv. 2013; 6(7): 746–755.
- MacMahon S, Duffy S, Rodgers A, et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths. Lancet. 2007; 370(9602): 1829–1839.
- Mihaylova B, Emberson J, Blackwell L, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012; 380(9841): 581–590.
- Gordon T, Castelli WP, Hjortland MC, et al. High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med. 1977; 62(5): 707–714.
- Sharrett AR, Ballantyne CM, Coady SA, et al. Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation. 2001; 104(10): 1108–1113.
- Nissen SE, Tuzcu EM, Schoenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA. 2004; 291(9): 1071–1080.
- Nicholls S, Tuzcu E, Sipahi I, et al. Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. JAMA. 2007; 297(5): 499.
- Thygesen K, Alpert JS, Jaffe AS, et al. Writing Group on the Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, ESC Committee for Practice Guidelines (CPG). Third universal definition of myocardial infarction. Eur Heart J. 2012; 33(20): 2551–2567.
- Glaser R, Selzer F, Faxon DP, et al. Clinical progression of incidental, asymptomatic lesions discovered during culprit vessel coronary intervention. Circulation. 2005; 111(2): 143–149.
- Virmani R, Kolodgie FD, Burke AP, et al. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol. 2000; 20(5): 1262–1275.
- Roleder T, Kovacic JC, Ali Z, et al. Combined NIRS and IVUS imaging detects vulnerable plaque using a single catheter system: a head-to-head comparison with OCT. EuroIntervention. 2014; 10(3): 303–311.
- Stone GW, Maehara A, Lansky AJ, et al. A prospective natural-history study of coronary atherosclerosis. N Engl J Med. 2011; 364(3): 226–235.
- Cheng JM, Garcia-Garcia HM, de Boer SPM, et al. In vivo detection of high-risk coronary plaques by radiofrequency intravascular ultrasound and cardiovascular outcome: results of the ATHEROREMO-IVUS study. Eur Heart J. 2014; 35(10): 639–647.
- Glagov S, Weisenberg E, Zarins CK, et al. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med. 1987; 316(22): 1371–1375.
- Gardner CM, Tan H, Hull EL, et al. Detection of lipid core coronary plaques in autopsy specimens with a novel catheter-based near-infrared spectroscopy system. JACC Cardiovasc Imaging. 2008; 1(5): 638–648.
- Schuurman AS, Vroegindewey M, Kardys I, et al. Near-infrared spectroscopy-derived lipid core burden index predicts adverse cardiovascular outcome in patients with coronary artery disease during long-term follow-up. Eur Heart J. 2018; 39(4): 295–302.
- Oemrawsingh RM, Cheng JM, García-García HM, et al. Near-infrared spectroscopy predicts cardiovascular outcome in patients with coronary artery disease. J Am Coll Cardiol. 2014; 64(23): 2510–2518.
- Kini AS, Baber U, Kovacic JC, et al. Changes in plaque lipid content after short-term intensive versus standard statin therapy: the YELLOW trial (reduction in yellow plaque by aggressive lipid-lowering therapy). J Am Coll Cardiol. 2013; 62(1): 21–29.
- Sachdeva A, Cannon CP, Deedwania PC, et al. Lipid levels in patients hospitalized with coronary artery disease: an analysis of 136,905 hospitalizations in Get With The Guidelines. Am Heart J. 2009; 157(1): 111–117.e2.
- Nagasawa Y, Shinke T, Toh R, et al. The impact of serum trans fatty acids concentration on plaque vulnerability in patients with coronary artery disease: Assessment via optical coherence tomography. Atherosclerosis. 2017; 265: 312–317.
- Rosenson RS, Brewer HB, Davidson WS, et al. Cholesterol efflux and atheroprotection: advancing the concept of reverse cholesterol transport. Circulation. 2012; 125(15): 1905–1919.
- Navab M, Reddy ST, Van Lenten BJ, et al. HDL and cardiovascular disease: atherogenic and atheroprotective mechanisms. Nat Rev Cardiol. 2011; 8(4): 222–232.
- Honda S, Sidharta SL, Shishikura D, et al. High-density lipoprotein cholesterol associated with change in coronary plaque lipid burden assessed by near infrared spectroscopy. Atherosclerosis. 2017; 265: 110–116.
- Park SJ, Kang SJ, Ahn JM, et al. Effect of statin treatment on modifying plaque composition: a double-blind, randomized study. J Am Coll Cardiol. 2016; 67(15): 1772–1783.
- Hong MK, Park DW, Lee CW, et al. Effects of statin treatments on coronary plaques assessed by volumetric virtual histology intravascular ultrasound analysis. JACC Cardiovasc Interv. 2009; 2(7): 679–688.
- Campeau L, Enjalbert M, Lespérance J, et al. The relation of risk factors to the development of atherosclerosis in saphenous-vein bypass grafts and the progression of disease in the native circulation. A study 10 years after aortocoronary bypass surgery. N Engl J Med. 1984; 311(21): 1329–1332.
- Danek BA, Karatasakis A, Alame AJ, et al. Saphenous vein graft near-infrared spectroscopy imaging insights from the lipid core plaque association with clinical events near-infrared spectroscopy (ORACLE-NIRS) registry. Catheter Cardiovasc Interv. 2017; 89(6): E172–E180.
