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Lipid Lowering Therapy to Modify Plaque Microstructures: Insights from Optical Coherence Tomography Imaging

View Article: PubMed Central - PubMed

ABSTRACT

Due to the pandemics of obesity and diabetes mellitus, especially in the Western countries, atherosclerotic cardiovascular disease (ASCVD) has become a major health burden and is expected to increase in the future. Modifying lipid targets, especially low-density lipoprotein cholesterol (LDL-C) level, has become the first-line therapy for primary and secondary prevention of ASCVD. Intravascular imaging modalities have contributed to elucidating clinical efficacy of lipid lowering therapy on atherosclerotic plaques. Optical coherence tomography (OCT) is a high-resolution imaging tool enables visualization of plaque microstructures associated with its instability. This modality has demonstrated favorable changes in plaque microstructures under lowering LDL-C level. In addition, clinical studies using OCT have suggested potential association of other lipid targets, including triglyceride and high-density lipoprotein cholesterol with plaque microstructures. Given continuing cardiovascular risks despite statin therapy, OCT will be an important imaging modality to evaluate novel therapeutic approaches that potentially modulates plaque instability.

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Achieving Very Low LDL-C Level and Plaque Microstructuresfibrous cap thicknesslipid arcTCFALDL-C = low-density lipoprotein cholesterol, TCFA = thin-cap fibroatheroma
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Figure 2: Achieving Very Low LDL-C Level and Plaque Microstructuresfibrous cap thicknesslipid arcTCFALDL-C = low-density lipoprotein cholesterol, TCFA = thin-cap fibroatheroma

Mentions: The association of achieved LDL-C level with plaque microstructures at non-culprit lesions was investigated in another retrospective analysis.31). This study included 280 patients with CAD who received a statin. LDL-C levels < 50 mg/dl and 70 mg/dl were achieved by 13.9% and 29.2% of study subjects, respectively. Fibrous cap thickness was thicker and lipid arc was smaller in association with achieved LDL-C level (Fig. 2-a and -b). Patients with LDL-C < 50 mg/dl exhibited the thickest fibrous cap, smallest lipid arc, and the lowest frequency of thin-cap fibroatheroma (Fig. 2a, b, and c). Even after adjusting for differences in clinical demographics, LDL-C level (β coefficient = −0.254, p = 0.009) and high-dose statin use (β coefficient = 1.814, p = 0.003) were independent determinants for fibrous cap thickness. Subgroup analysis elucidated consistent efficacy of achieving very low LDL-C levels in various subsets except diabetic patients (Table 2). Favorable effects of achieving very low LDL-C level on fibrous cap thickness were observed in non-diabetic subjects (94.6 ± 52.9 vs. 203.5 ± 93.7 µm, p < 0.001), whereas there was no significant difference in fibrous cap thickness of diabetic patients with LDL-C < vs. > 50 mg/dl (106.4 ± 86.9 vs. 93.2 ± 79.6 µm, p = 0.27).


Lipid Lowering Therapy to Modify Plaque Microstructures: Insights from Optical Coherence Tomography Imaging
Achieving Very Low LDL-C Level and Plaque Microstructuresfibrous cap thicknesslipid arcTCFALDL-C = low-density lipoprotein cholesterol, TCFA = thin-cap fibroatheroma
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5392473&req=5

Figure 2: Achieving Very Low LDL-C Level and Plaque Microstructuresfibrous cap thicknesslipid arcTCFALDL-C = low-density lipoprotein cholesterol, TCFA = thin-cap fibroatheroma
Mentions: The association of achieved LDL-C level with plaque microstructures at non-culprit lesions was investigated in another retrospective analysis.31). This study included 280 patients with CAD who received a statin. LDL-C levels < 50 mg/dl and 70 mg/dl were achieved by 13.9% and 29.2% of study subjects, respectively. Fibrous cap thickness was thicker and lipid arc was smaller in association with achieved LDL-C level (Fig. 2-a and -b). Patients with LDL-C < 50 mg/dl exhibited the thickest fibrous cap, smallest lipid arc, and the lowest frequency of thin-cap fibroatheroma (Fig. 2a, b, and c). Even after adjusting for differences in clinical demographics, LDL-C level (β coefficient = −0.254, p = 0.009) and high-dose statin use (β coefficient = 1.814, p = 0.003) were independent determinants for fibrous cap thickness. Subgroup analysis elucidated consistent efficacy of achieving very low LDL-C levels in various subsets except diabetic patients (Table 2). Favorable effects of achieving very low LDL-C level on fibrous cap thickness were observed in non-diabetic subjects (94.6 ± 52.9 vs. 203.5 ± 93.7 µm, p < 0.001), whereas there was no significant difference in fibrous cap thickness of diabetic patients with LDL-C < vs. > 50 mg/dl (106.4 ± 86.9 vs. 93.2 ± 79.6 µm, p = 0.27).

View Article: PubMed Central - PubMed

ABSTRACT

Due to the pandemics of obesity and diabetes mellitus, especially in the Western countries, atherosclerotic cardiovascular disease (ASCVD) has become a major health burden and is expected to increase in the future. Modifying lipid targets, especially low-density lipoprotein cholesterol (LDL-C) level, has become the first-line therapy for primary and secondary prevention of ASCVD. Intravascular imaging modalities have contributed to elucidating clinical efficacy of lipid lowering therapy on atherosclerotic plaques. Optical coherence tomography (OCT) is a high-resolution imaging tool enables visualization of plaque microstructures associated with its instability. This modality has demonstrated favorable changes in plaque microstructures under lowering LDL-C level. In addition, clinical studies using OCT have suggested potential association of other lipid targets, including triglyceride and high-density lipoprotein cholesterol with plaque microstructures. Given continuing cardiovascular risks despite statin therapy, OCT will be an important imaging modality to evaluate novel therapeutic approaches that potentially modulates plaque instability.

No MeSH data available.


Related in: MedlinePlus