Clinical Predictors of Plaque Progression Despite Very Low Levels of Low-Density Lipoprotein Cholesterol
Open accessAbstract
Objectives The purpose of this study was to characterize the determinants of plaque progression despite achieving very low levels of low-density lipoprotein cholesterol (LDL-C).Background Despite achieving very low levels of LDL-C, many patients continue to demonstrate disease progression and have clinical events.Methods A total of 3,437 patients with coronary artery disease underwent serial intravascular ultrasound examination in 7 clinical trials. Patients who achieved an on-treatment LDL-C level of <or=70 mg/dl (n = 951) were stratified as progressors (n = 200) and nonprogressors (n = 751) and compared.Results Despite achieving LDL-C <or=70 mg/dl, >20% of patients continued to progress. There were no demographic differences between groups. Progressors demonstrated higher baseline levels of glucose (117.1 +/- 42.5 mg/dl vs. 112.1 +/- 40.0 mg/dl, p = 0.02), triglycerides (157.5 mg/dl vs. 133.0 mg/dl, p = 0.004), and a smaller decrease of apolipoprotein B (-25.1 +/- 3.4 mg/dl vs. -27.4 +/- 3.35 mg/dl, p = 0.01) at follow-up. Multivariable analysis revealed that independently associated risk factors of progression in patients with LDL-C <or=70 mg/dl included baseline percent atheroma volume (p = 0.001), presence of diabetes mellitus (p = 0.02), increase in systolic blood pressure (p = 0.001), less increase in high-density lipoprotein cholesterol (p = 0.01), and a smaller decrease in apolipoprotein B levels (p = 0.001), but not changes in C-reactive protein (p = 0.78) or LDL-C (p = 0.84).Conclusions Residual risk factors are associated with the likelihood of disease progression in patients who achieve very low LDL-C levels. In addition, the association between apolipoprotein B and atheroma progression highlights the potential importance of LDL particle concentration in patients with optimal LDL-C control. This finding highlights the need for intensive modification of global risk in patients with coronary artery disease.
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Complication of cerebrovascular disease is a high-risk condition for cardiovascular events in both Japan and the United States.
“However, it was confirmed that the complication of cerebrovascular disease is a high-risk condition for cardiovascular event in both Japan and the United States752).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [752]
Patients with chronic kidney disease and a serum creatinine level of at least 2.0 mg/dL were found to have a 7.0-fold increased risk for total mortality.
“Furthermore, patients with CKD and a serum creatinine level ≥ 2.0 mg/dL were found to have a 7.0-fold increased risk for total mortality.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [752]
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- Authors
- Bayturan, O., Kapadia, S., Nicholls, S. J., Tuzcu, E. M., Shao, M., Uno, K., Shreevatsa, A., Lavoie, A. J., Wolski, K., Schoenhagen, P., & Nissen, S. E.
- Affiliations
- Cleveland Clinic (US)
- Case Western Reserve University (US)
- Corresponding author
- Nicholls, Stephen J.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2010-06
- Volume
- 55
- Issue
- 24
- Pages
- 2736-2742
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2080152964
- Cited by
- 174
- References
- 32
- Citations by year
- 2026: 6 · 2025: 14 · 2024: 8 · 2023: 12 · 2022: 6 · 2021: 5 · 2020: 11 · 2019: 9 · 2018: 11 · 2017: 13 · 2016: 11 · 2015: 9 · 2014: 11 · 2013: 18 · 2012: 11
- FWCI
- 15.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Institutional Repositories DataBase (IRDB) (submittedVersion)
- Funders
- Scientific and Technological Research Council of Turkey
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- coronary artery disease, atheroma progression, very low LDL cholesterol, apolipoprotein B, residual cardiovascular risk, diabetes mellitus, systolic blood pressure, HDL cholesterol, triglycerides, intravascular ultrasound, atheroma volume, C-reactive protein
- MeSH terms
- Coronary Disease, Coronary Vessels, Female, Follow-Up Studies, Humans, Cholesterol, LDL, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Risk Factors, Ultrasonography, Interventional, Disease Progression, Atherosclerosis
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