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http://dx.doi.org/10.4070/kcj.2013.43.1.23

Hypercholesterolemia and In-Vivo Coronary Plaque Composition in Patients with Coronary Artery Disease: A Virtual Histology - Intravascular Ultrasound Study  

Seo, Young Hoon (Division of Cardiology, Heart Center, Konyang University Hospital)
Lee, Chung Seop (Division of Cardiology, Heart Center, Konyang University Hospital)
Yuk, Hyung Bin (Division of Cardiology, Heart Center, Konyang University Hospital)
Yang, Dong Ju (Division of Cardiology, Heart Center, Konyang University Hospital)
Park, Hyun Woong (Division of Cardiology, Heart Center, Konyang University Hospital)
Kim, Ki Hong (Division of Cardiology, Heart Center, Konyang University Hospital)
Kim, Wan Ho (Division of Cardiology, Heart Center, Konyang University Hospital)
Kwon, Taek-Geun (Division of Cardiology, Heart Center, Konyang University Hospital)
Bae, Jang-Ho (Division of Cardiology, Heart Center, Konyang University Hospital)
Publication Information
Korean Circulation Journal / v.43, no.1, 2013 , pp. 23-28 More about this Journal
Abstract
Background and Objectives: Hypercholesterolemia is a key factor in the development of atherosclerosis. We sought to evaluate the relation between hypercholesterolemia and plaque composition in patients with coronary artery disease. Subjects and Methods: Study subjects consisted of 323 patients (mean 61.5 years, 226 males) who underwent coronary angiography and virtual histology-intravascular ultrasound examination. Patients were divided into two groups according to total cholesterol level: hypercholesterolemic group (${\geq}$200 mg/dL, n=114) and normocholesterolemic group (<200 mg/dL, n=209). Results: Hypercholesterolemic patients were younger ($59.7{\pm}13.3$ years vs. $62.6{\pm}11.5$ years, p=0.036), than normocholesterolemic patients, whereas there were no significant differences in other demographics. Hypercholesterolemic patients had higher corrected necrotic core volume ($1.23{\pm}0.85mm^3$/mm vs. $1.02{\pm}0.80mm^3$/mm, p=0.029) as well as percent necrotic core volume ($20.5{\pm}8.5$% vs. $18.0{\pm}9.2%$, p=0.016) than normocholesterolemic patients. At the minimal lumen area site, percent necrotic core area ($21.4{\pm}10.5%$ vs. $18.4{\pm}11.3%$, p=0.019) and necrotic core area ($1.63{\pm}1.09mm^2$ vs. $1.40{\pm}1.20mm^2$, p=0.088) were also higher than normocholesterolemic patients. Multivariate linear regression analysis showed that total cholesterol level was an independent factor of percent necrotic core volume in the culprit lesion after being adjusted with age, high density lipoprotein-cholesterol, hypertension, diabetes mellitus, smoking and acute coronary syndrome (beta 0.027, 95% confidence interval 0.02-0.053, p=0.037). Conclusion: Hypercholesterolemia was associated with increased necrotic core volume in coronary artery plaque. This study suggests that hypercholesterolemia plays a role in making plaque more complex, which is characterized by a large necrotic core, in coronary artery disease.
Keywords
Hypercholesterolemia; Coronary artery disease; Ultrasonography; Interventional plaque; Atherosclerotic;
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1 Nair A, Margolis MP, Kuban BD, Vince DG. Automated coronary plaque characterisation with intravascular ultrasound backscatter: ex vivo validation. EuroIntervention 2007;3:113-20.
2 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97.   DOI   ScienceOn
3 Jellinger PS, Smith DA, Mehta AE, et al. American Association of Clinical Endocrinologists' Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis. Endocr Pract 2012;18 Suppl 1:1-78.   DOI   ScienceOn
4 Hong SJ, Oh DJ, Kim EJ, et al. The comparison of serum lipid levels and risk factors according to the status of coronary atherosclerosis in Koreans. Korean Circ J 2003;33:465-74.   DOI
5 Mintz GS, Nissen SE, Anderson WD, et al. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2001;37:1478-92.   DOI   ScienceOn
6 Marso SP, Mercado N, Maehara A, et al. Plaque composition and clinical outcomes in acute coronary syndrome patients with metabolic syndrome or diabetes. JACC Cardiovasc Imaging 2012;5(3 Suppl):S42-52.   DOI   ScienceOn
7 Bae JH, Kwon TG, Kim KH, et al. In-vivo coronary plaque composition in patients with acute coronary syndrome: a virtual histology intravascular ultrasound study. Korean Circ J 2007;37:437-42.   DOI   ScienceOn
8 Kawaguchi R, Oshima S, Jingu M, et al. Usefulness of virtual histology intravascular ultrasound to predict distal embolization for ST-segment elevation myocardial infarction. J Am Coll Cardiol 2007;50:1641-6.   DOI   ScienceOn
9 Missel E, Mintz GS, Carlier SG, et al. Necrotic core and its ratio to dense calcium are predictors of high-risk non-ST-elevation acute coronary syndrome. Am J Cardiol 2008;101:573-8.   DOI   ScienceOn
10 Hong MK, Mintz GS, Lee CW, et al. Comparison of virtual histology to intravascular ultrasound of culprit coronary lesions in acute coronary syndrome and target coronary lesions in stable angina pectoris. Am J Cardiol 2007;100:953-9.   DOI   ScienceOn
11 Kröner ES, van Velzen JE, Boogers MJ, et al. Positive remodeling on coronary computed tomography as a marker for plaque vulnerability on virtual histology intravascular ultrasound. Am J Cardiol 2011;107: 1725-9.   DOI   ScienceOn
12 Barter P. CETP and atherosclerosis. Arterioscler Thromb Vasc Biol 2000; 20:2029-31.   DOI   ScienceOn
13 Naghavi M, Libby P, Falk E, et al. From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: part I. Circulation 2003;108:1664-72.   DOI   ScienceOn
14 Assmann G, Schulte H, von Eckardstein A, Huang Y. High-density lipoprotein cholesterol as a predictor of coronary heart disease risk. The PROCAM experience and pathophysiological implications for reverse cholesterol transport. Atherosclerosis 1996;124 Suppl:S11-20.   DOI
15 Fuster V, Badimon L, Badimon JJ, et al. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med 1992; 326:242-50.   DOI   ScienceOn
16 Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000; 20:1262-75.   DOI   ScienceOn
17 Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol 2006;47(8 Suppl):C13-8.   DOI   ScienceOn
18 Steinberg D. Lewis A. Conner Memorial Lecture. Oxidative modification of LDL and atherogenesis. Circulation 1997;95:1062-71.   DOI   ScienceOn
19 Berliner JA, Watson AD. A role for oxidized phospholipids in atherosclerosis. N Engl J Med 2005;353:9-11.   DOI   ScienceOn
20 Fan J, Watanabe T. Inflammatory reactions in the pathogenesis of atherosclerosis. J Atheroscler Thromb 2003;10:63-71.   DOI   ScienceOn
21 Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005;352:1685-95.   DOI   ScienceOn
22 Nair A, Kuban BD, Tuzcu EM, Schoenhagen P, Nissen SE, Vince DG. Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 2002;106:2200-6.   DOI   ScienceOn
23 Raichlin E, Bae JH, Kushwaha SS, et al. Inflammatory burden of cardiac allograft coronary atherosclerotic plaque is associated with early recurrent cellular rejection and predicts a higher risk of vasculopathy progression. J Am Coll Cardiol 2009;53:1279-86.   DOI   ScienceOn
24 Rodriguez-Granillo GA, McFadden EP, Valgimigli M, et al. Coronary plaque composition of nonculprit lesions, assessed by in vivo intracoronary ultrasound radio frequency data analysis, is related to clinical presentation. Am Heart J 2006;151:1020-4.   DOI   ScienceOn
25 Nasu K, Tsuchikane E, Katoh O, et al. Accuracy of in vivo coronary plaque morphology assessment: a validation study of in vivo virtual histology compared with in vitro histopathology. J Am Coll Cardiol 2006; 47:2405-12.   DOI   ScienceOn