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Progression of coronary atherosclerosis in patients without standard modifiable risk factors
Jawad Mazhar1, Gemma Figtree1, Stephen T Vernon1
1Kolling Research Institute, University of Sydney, Sydney, Australia.
Insights
Patients with coronary artery disease but no traditional risk factors show similar plaque progression rates compared to those with risk factors. This finding is crucial for understanding atherosclerosis development in diverse patient groups.
Area of Science:
- Cardiology
- Vascular Biology
- Atherosclerosis Research
Background:
- The progression of coronary artery disease (CAD) in patients lacking traditional risk factors remains incompletely understood.
- Investigating these patients is vital for a comprehensive understanding of atherosclerosis.
Purpose of the Study:
- To compare clinical characteristics and arterial plaque burden in patients with CAD who have standard modifiable risk factors versus those who do not.
- To assess the rate of plaque progression in these two groups.
Main Methods:
- A comparative analysis was conducted on a cohort of patients from anti-atherosclerotic therapy trials.
- Intravascular ultrasonography was used to assess plaque burden serially.
- Patients were stratified into groups with (n=492) and without (n=165) standard modifiable risk factors, matched for age, sex, and statin use.
Main Results:
- Patients without traditional risk factors exhibited lower baseline systolic blood pressure, LDL cholesterol, triglycerides, and C-reactive protein.
- Baseline plaque burden, including percent atheroma and total atheroma volume, was lower in the no-risk-factor group.
- Despite baseline differences, the rate of plaque progression, measured by changes in atheroma volume and the percentage of patients with progression, was similar between groups.
Conclusions:
- Clinical coronary atherosclerosis develops and progresses similarly in patients with and without standard modifiable risk factors.
- These findings suggest that factors beyond traditional risk factors play a significant role in CAD progression.
Background And Aims:
The outcome of patients with clinical coronary artery disease despite traditional risk factors is poorly understood.
Methods:
Clinical characteristics and plaque burden on serial intravascular ultrasonography were compared in patients without (n = 165) and with (n = 492) standard modifiable risk factors after matching on age, sex and use of statins from a database of 5823 patients participating in clinical trials of anti-atherosclerotic therapies.
Results:
Patients without standard modifiable risk factors had lower baseline systolic blood pressure (118 ± 12 vs. 129 ± 17 mmHg, p < 0.001), low-density lipoprotein cholesterol (87 ± 21 vs. 104 ± 34 mg/dl, p < 0.001), triglycerides [106 vs. 136 mg/dl, p < 0.001)] and C-reactive protein [1.5 vs. 2.1 mg/l, p = 0.001]. At baseline, patients without modifiable risk factors had a lower percent atheroma volume (35.7 ± 8.6 vs. 38 ± 8.8%, p = 0.004) and total atheroma volume (174.7 ± 80 vs. 190.9 ± 84 mm3, p = 0.03) and less images with calcification (22.2 vs. 26.5%, p = 0.025). The use of aspirin and statin prior to and during the trials was similar. The use of ACE inhibitors and beta blockers was lower in the no risk factor group prior to and during the trials. The change in percent atheroma volume (-0.2 ± 2.8 vs. -0.1 ± 3.6%, p = 0.71), total atheroma volume (-5.5 ± 23.4 vs. -3.8 ± 22.7 mm3, p = 0.42), and the percentage of patients demonstrating any degree of progression (50.9% vs 45.1%, p = 0.20) were similar in those without and with standard modifiable risk factors, respectively.
Conclusion:
Patients who develop clinical coronary atherosclerosis without standard modifiable risk factors have similar rates of plaque progression to those with traditional risk factors.
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