Culprit Lesion Characteristics in Young Patients with Hyperhomocysteinemia

Area of Science:

• Cardiovascular Research
• Atherosclerosis Imaging
• Clinical Lipidology

Background:

• The link between hyperhomocysteinemia (HHcy) and coronary plaque characteristics in young patients remains unclear.
• Understanding these relationships is crucial for early atherosclerosis detection and management.

Purpose of the Study:

• To investigate the association between culprit atherosclerotic plaque phenotype, assessed by optical coherence tomography (OCT), and HHcy in young patients (≤45 years).

Main Methods:

• OCT imaging and HHcy levels were analyzed for 123 lesions in 123 young patients.
• Culprit lesions were classified as thin-cap fibroatheroma (TCFA), thrombus, or other.
• Patients were grouped into HHcy (≥15.5 µmol/l) and control (<15.5 µmol/l) groups.

Main Results:

• The HHcy group showed a higher prevalence of OCT-TCFA, OCT-vasa vasorum, and OCT-thrombus compared to controls.
• A larger lipid arc was observed in the HHcy group.
• HHcy and metabolic syndrome (MetS) independently predicted TCFAs, while HHcy and smoking predicted thrombus.

Conclusions:

• HHcy is associated with TCFAs and thrombus formation in young patients with coronary artery disease.
• Metabolic syndrome and smoking are also significant contributing factors in these young patients.