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Coronary plaque vulnerability in statin-treated patients with elevated LDL-C and hs-CRP: optical coherence tomography study

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Abstract

There have been no previous attempts to assess coronary plaque morphology in statin-treated patients with combined residual cholesterol and inflammatory risk. The aim of this study was to characterize the morphology using optical coherence tomography (OCT) and to investigate the underlying molecular mechanisms. Two hundred seventy statin-treated patients with stable coronary artery disease who underwent OCT imaging prior to elective percutaneous coronary intervention were included in this single-center retrospective analysis. Subjects were stratified into four groups based on low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP) levels using 70 mg/dl and 2 mg/L as cut-offs, respectively. OCT images of the target lesions were assessed. For a subset of patients, peripheral blood mononuclear cells (PBMC) were isolated, and gene expression was characterized using microarray analysis. Patients with high LDL-C and high hs-CRP demonstrated a higher frequency of lipid-rich plaques (LRP) (91%, P = 0.03) by OCT. LRPs in these patients had a greater maximal lipid arc (186.6 ± 92.5°, P = 0.047). In addition, plaques from patients who did not achieve dual-target were less frequently calcified (P = 0.003). If calcification was present, it was characterized by a lower maximal arc (P = 0.016) and shorter length (P = 0.025). PBMC gene expression analysis demonstrated functional enrichment of toll-like receptors (TLRs) 1–9 to be associated with high LDL-C and hs-CRP. Obstructive coronary lesions in patients on statin therapy with combined residual cholesterol and inflammatory risk demonstrated a higher prevalence of LRP with greater maximal lipid arcs and more frequent spotty calcifications. PBMC from these patients revealed functional enrichment of TLR 1–9.

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Authors and Affiliations

  1. Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine At Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA

    Surbhi Chamaria, Hiroki Ueyama, Keisuke Yasumura, Kipp W. Johnson, Yuliya Vengrenyuk, Naotaka Okamoto, Nitin Barman, Samit Bhatheja, Vishal Kapur, Choudhury Hasan, Joseph Sweeney, Usman Baber, Samin K. Sharma, Jagat Narula & Annapoorna S. Kini

  2. Department of Medicine, Icahn School of Medicine At Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA

    Hiroki Ueyama

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Contributions

SC, KWJ, YV, UB, SKS, JN, and ASK contributed to conception and design, drafting and revising the manuscript, and final approval of manuscript submitted. HU, KY, NO, NB, SB, MD, VK, CH, and JS contributed to interpretation of data, drafting and revising the manuscript, and final approval of manuscript submitted.

Corresponding author

Correspondence to Annapoorna S. Kini.

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Conflict of interest

Dr. Barman reports speaker/consultant fees from Boston Scientific, Cardiovascular Systems, Inc., and Terumo Medical. Dr. Baber has received speaker honoraria from AstraZeneca and Boston Scientific and has received honoraria from Amgen. Dr. Sharma reports honoraria from Abbot Vascular, Boston Scientific, and Cardiovascular Systems, Inc. for Speaker’s Bureau. The other authors have nothing to disclose.

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Patients were selected from institutional review board-approved clinical and imaging database of the Mount Sinai catheterization laboratory.

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Chamaria, S., Ueyama, H., Yasumura, K. et al. Coronary plaque vulnerability in statin-treated patients with elevated LDL-C and hs-CRP: optical coherence tomography study. Int J Cardiovasc Imaging 38, 1157–1167 (2022). https://doi.org/10.1007/s10554-021-02238-8

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