Association Between Visit-to-Visit Variability in Low-Density Lipoprotein Cholesterol and Plaque Rupture That Leads to Acute Coronary Syndrome

Area of Science:

• Cardiology
• Lipid Metabolism
• Vascular Biology

Background:

• Intraindividual variability in lipid levels and its impact on acute coronary syndrome (ACS) onset are not fully understood.
• Optical coherence tomography (OCT) is crucial for characterizing culprit lesion morphologies in ACS.

Purpose of the Study:

• To investigate the association between intraindividual variability in lipid levels and culprit lesion morphologies in ACS patients.
• To determine if lipid variability predicts specific ACS subtypes, particularly plaque rupture ACS (PR-ACS).

Main Methods:

• A study cohort included 74 ACS patients with ≥3 pre-ACS outpatient lipid assessments and 222 controls.
• ACS patients were classified into PR-ACS (n=44) or non-plaque rupture ACS (NPR-ACS) (n=30) groups based on OCT findings.
• Visit-to-visit variability was quantified using corrected variability independent of the mean (cVIM) for lipid levels.

Main Results:

• ACS patients exhibited higher low-density lipoprotein cholesterol (LDL-C) levels and cVIM compared to controls.
• The PR-ACS group showed significantly higher mean LDL-C and greater LDL-C cVIM than controls.
• Higher LDL-C cVIM independently predicted PR-ACS (OR 1.06; P=0.018), even with similar mean LDL-C levels between PR-ACS and NPR-ACS groups.

Conclusions:

• Visit-to-visit variability in LDL-C levels, in addition to the absolute LDL-C level, is associated with ACS onset.
• Increased LDL-C variability is a potential predictor of ACS specifically driven by plaque rupture.