Correlation between high density lipoprotein-cholesterol and remodeling index in patients with coronary artery disease: IDEAS (IVUS diagnostic evaluation of atherosclerosis in Singapore)-HDL study

  • Chi-Hang Lee
  • Bee-Choo Tai
  • Gek-Hsiang Lim
  • Mark Y. Chan
  • Adrian F. Low
  • Kathryn C. Tan
  • Boon-Lock Chia
  • Huay-Cheem Tan
Original Paper

Abstract

Serum level of high density lipoprotein (HDL)-cholesterol is associated with risk of coronary artery disease. We correlated the serum level of cholesterol with coronary artery remodeling index of patients with coronary artery disease. A total of 120 patients with de novo lesions located in native coronary artery were studied. Remodeling index was based on intravascular ultrasound (IVUS) interrogation of the lesions using the static approach, and was defined as external elastic membrane (EEM) area at lesion/average EEM area at proximal and distal reference segments. The average remodeling index was 0.9 (SD: 0.2). The remodeling index was not associated with any of the demographic and coronary risk factors. Stable angina was associated with a low remodeling index. Remodeling index correlated with white blood cell count and HDL-cholesterol, but not with total cholesterol, LDL-cholesterol and triglyceride. In the multiple linear regression analysis, HDL-cholesterol and procedure indication were the only 2 significant predictors of remodeling index. An increase of 1 mg/dL of HDL-cholesterol resulted in a decrease of 0.003 (95% CI: 0.0001, 0.007; P = 0.046) in remodeling index, after adjusting for procedural indications. When stratified according to diabetic status, the negative correlation persisted in non-diabetic (P = 0.023), but not in diabetic, patients (P = 0.707). We found a negative correlation between HDL-cholesterol level and remodeling index. Diabetic status may have an influence on the observed relationship.

Keywords

High density lipoprotein cholesterol Coronary artery Remodeling index Intravascular ultrasound 

Notes

Acknowledgments

The authors would like to thank the Publication Support Unit of the National University Health System, Singapore, for its assistance in the preparation of this manuscript. Start-up Grant, Yong Loo Lin School of Medicine, National University of Singapore.

References

  1. 1.
    Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ (1987) Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 316:1371–1375PubMedCrossRefGoogle Scholar
  2. 2.
    Hermiller JB, Tenaglia AN, Kisslo KB, Phillips HR, Bashore TM, Stack RS, Davidson CJ (1993) In vivo validation of compensatory enlargement of atherosclerotic coronary arteries. Am J Cardiol 71:665–668PubMedCrossRefGoogle Scholar
  3. 3.
    Schoenhagen P, Ziada KM, Kapadia SR, Crowe TD, Nissen SE, Tuzcu EM (2000) Extent and direction of arterial remodeling in stable versus unstable coronary syndromes: an intravascular ultrasound study. Circulation 101:598–603PubMedGoogle Scholar
  4. 4.
    Nakamura M, Nishikawa H, Mukai S, Setsuda M, Nakajima K, Tamada H, Suzuki H, Ohnishi T, Kakuta Y, Nakano T, Yeung AC (2001) Impact of coronary artery remodeling on clinical presentation of coronary artery disease: an intravascular ultrasound study. J Am Coll Cardiol 37:63–69PubMedCrossRefGoogle Scholar
  5. 5.
    Nicholls SJ, Tuzcu EM, Kalidindi S, Wolski K, Moon KW, Sipahi I, Schoenhagen P, Nissen SE (2008) Effect of diabetes on progression of coronary atherosclerosis and arterial remodeling: a pooled analysis of 5 intravascular ultrasound trials. J Am Coll Cardiol 52:255–562PubMedCrossRefGoogle Scholar
  6. 6.
    Schoenhagen P, Tuzcu EM, Apperson-Hansen C, Wang C, Wolski K, Lin S, Sipahi I, Nicholls SJ, Magyar WA, Loyd A, Churchill T, Crowe T, Nissen SE (2006) Determinants of arterial wall remodeling during lipid-lowering therapy: serial intravascular ultrasound observations from the reversal of atherosclerosis with aggressive lipid lowering therapy (REVERSAL) trial. Circulation 113:2826–2834PubMedCrossRefGoogle Scholar
  7. 7.
    Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR (1977) High density lipoprotein as a protective factor against coronary heart disease: the Framingham study. Am J Med 62:707–714PubMedCrossRefGoogle Scholar
  8. 8.
    Gordon DJ, Rifkind BM (1989) High-density lipoprotein—the clinical implications of recent studies. N Engl J Med 321:1311–1316PubMedCrossRefGoogle Scholar
  9. 9.
    Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, Kastelein JJ, Bittner V, Fruchart JC (2007) Treating to new targets investigators. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 357:1301–1310PubMedCrossRefGoogle Scholar
  10. 10.
    Maccubbin D, Bays HE, Olsson AG, Elinoff V, Elis A, Mitchel Y, Sirah W, Betteridge A, Reyes R, Yu Q, Kuznetsova O, Sisk CM, Pasternak RC, Paolini JF (2008) Lipid-modifying efficacy and tolerability of extended-release niacin/laropiprant in patients with primary hypercholesterolaemia or mixed dyslipidaemia. Int J Clin Pract 62:1959–1970PubMedCrossRefGoogle Scholar
  11. 11.
    Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, Pinto FJ, Rosenfield K, Siegel RJ, Tuzcu EM, Yock PG (2001) 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 37:1478–1492PubMedCrossRefGoogle Scholar
  12. 12.
    Tauth J, Pinnow E, Sullebarger JT, Basta L, Gursoy S, Lindsay J Jr, Matar F (1997) Predictors of coronary arterial remodeling patterns in patients with myocardial ischemia. Am J Cardiol 80:1352–1355PubMedCrossRefGoogle Scholar
  13. 13.
    Mintz GS, Kent KM, Pichard AD, Satler LF, Popma JJ, Leon MB (1997) Contribution of inadequate arterial remodeling to the development of focal coronary artery stenoses: an intravascular ultrasound study. Circulation 95:1791–1798PubMedGoogle Scholar
  14. 14.
    Sabate’ M, Kay IP, de Feyter PJ, van Domburg RT, Deshpande NV, Ligthart JM, Gijzel AL, Wardeh AJ, Boersma E, Serruys PW (1999) Remodeling of atherosclerotic coronary arteries varies in relation to location and composition of plaque. Am J Cardiol 94:135–140CrossRefGoogle Scholar
  15. 15.
    Raffel OC, Merchant FM, Tearney GJ, Chia S, Gauthier DD, Pomerantsev E, Mizuno K, Bouma BE, Jang IK (2008) In vivo association between positive coronary artery remodelling and coronary plaque characteristics assessed by intravascular optical coherence tomography. Eur Heart J 29:1721–1728PubMedCrossRefGoogle Scholar
  16. 16.
    Varnava AM, Mills PG, Davies MJ (2002) Relationship between coronary artery remodeling and plaque vulnerability. Circulation 105:939–943PubMedCrossRefGoogle Scholar
  17. 17.
    Johnsen SH, Mathiesen EB, Fosse E, Joakimsen O, Stensland-Bugge E, Njølstad I, Arnesen E (2005) Elevated high-density lipoprotein cholesterol levels are protective against plaque progression: a follow-up study of 1952 persons with carotid atherosclerosis the Tromsø study. Circulation 112:498–504PubMedCrossRefGoogle Scholar
  18. 18.
    Nofer JR, Kehrel B, Fobker M, Levkau B, Assmann G, von Eckardstein A (2002) HDL and arteriosclerosis: beyond reverse cholesterol transport. Atherosclerosis 161:1–16PubMedCrossRefGoogle Scholar
  19. 19.
    Taylor AJ, Burke AP, Farb A, Yousefi P, Malcom GT, Smialek J, Virmani R (1999) Arterial remodeling in the left coronary system. J Am Coll Cardiol 34:760–767PubMedCrossRefGoogle Scholar
  20. 20.
    Jiménez-Quevedo P, Sabaté M, Angiolillo D, Alfonso F, Hernández-Antolín R, Bañuelos C, Bernardo E, Ramirez C, Moreno R, Fernández C, Escaned J, Macaya C (2005) LDL-cholesterol predicts negative coronary artery remodelling in diabetic patients: an intravascular ultrasound study. Eur Heart J 26:2307–2312PubMedCrossRefGoogle Scholar
  21. 21.
    Tan KC (2009) Reverse cholesterol transport in type 2 diabetes mellitus. Diabetes Obes Metab 11:534–543PubMedCrossRefGoogle Scholar
  22. 22.
    Schartl M, Bocksch W (2006) How to assess coronary artery remodeling by intravascular ultrasound. Am Heart J 152:414–416PubMedCrossRefGoogle Scholar
  23. 23.
    Sipahi I, Tuzcu EM, Schoenhagen P, Nicholls SJ, Crowe T, Kapadia S, Nissen SE (2006) Static and serial assessments of coronary arterial remodeling are discordant: an intravascular ultrasound analysis from the reversal of atherosclerosis with aggressive lipid lowering (REVERSAL) trial. Am Heart J 152:544–550PubMedCrossRefGoogle Scholar
  24. 24.
    Hibi K, Ward MR, Honda Y, Suzuki T, Jeremias A, Okura H, Hassan AH, Maehara A, Yeung AC, Pasterkamp G, Fitzgerald PJ, Yock PG (2005) Impact of different definitions on the interpretation of coronary remodeling determined by intravascular ultrasound. Catheter Cardiovasc Interv 65:233–239PubMedCrossRefGoogle Scholar
  25. 25.
    Ansell BJ, Watson KE, Fogelman AM, Navab M, Fonarow GC (2005) High-density lipoprotein function recent advances. J Am Coll Cardiol 46:1792–1798PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, B.V. 2010

Authors and Affiliations

  • Chi-Hang Lee
    • 1
    • 2
  • Bee-Choo Tai
    • 3
    • 4
  • Gek-Hsiang Lim
    • 3
  • Mark Y. Chan
    • 1
    • 2
  • Adrian F. Low
    • 1
    • 2
  • Kathryn C. Tan
    • 5
  • Boon-Lock Chia
    • 1
    • 2
  • Huay-Cheem Tan
    • 2
  1. 1.Department of MedicineYong Loo Lin School of Medicine, National University of SingaporeKent RidgeSingapore
  2. 2.National University Heart Centre Singapore, National University of SingaporeKent RidgeSingapore
  3. 3.Department of Epidemiology and Public HealthNational University of SingaporeKent RidgeSingapore
  4. 4.Investigational Medicine UnitNational University Health SystemKent RidgeSingapore
  5. 5.Department of MedicineUniversity of Hong KongPokfulamHong Kong

Personalised recommendations