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Potential of low apolipoprotein A-I as a surrogate marker of vulnerable carotid artery plaques
Saya Tsuchigauchi1, Toshinori Matsushige2, Yukishige Hashimoto3
1Department of Neurology, Hiroshima City North Medical Center Asa Citizens Hospital, Hiroshima, Japan.
Insights
Low apolipoprotein A-I (apoA-I) levels are linked to symptomatic carotid artery stenosis. This finding suggests apoA-I may serve as a marker for detecting unstable carotid plaques, improving stroke risk assessment.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Biochemistry
Background:
- Medical control of atherogenic lipoproteins is insufficient for stroke prevention.
- Low apolipoprotein A-I (apoA-I) levels may impact high-density lipoprotein (HDL-C) anti-atherogenic effects.
- ApoA-I is potentially associated with vulnerable plaques in carotid artery stenosis.
Purpose of the Study:
- Investigate the relationship between apolipoprotein A-I (apoA-I) levels and carotid artery stenosis status.
- Identify predictors of symptomatic carotid artery stenosis.
- Evaluate apoA-I as a potential marker for plaque instability.
Main Methods:
- Examined 91 patients with carotid artery stenosis, categorized into symptomatic (n=47) and asymptomatic (n=44).
- Assessed patient profiles, comorbidities, lipid data, and plaque features using ultrasonography, MRI, and digital subtraction angiography.
- Utilized multivariate logistic regression to identify risk factors for symptomatic stenosis.
Main Results:
- Symptomatic plaques showed ulceration, low echo luminance, and high T1 signal intensity.
- Symptomatic patients had significantly lower levels of apoA-I, total cholesterol, and non-HDL-C.
- Low apoA-I, ulceration, and low echo luminance predicted symptomatic stenosis (diagnostic accuracy 0.84 when combined with high T1 signal intensity).
Conclusions:
- Low apolipoprotein A-I (apoA-I) levels are significantly associated with symptomatic carotid artery stenosis.
- ApoA-I levels show potential as a surrogate marker for identifying unstable carotid plaques.
- This highlights the importance of apoA-I in assessing stroke risk in patients with carotid artery disease.
Objective:
Recent studies suggested that the medical control of atherogenic lipoproteins is not sufficient for stroke prevention. A low apolipoprotein A-I (apoA-I) level may play a crucial role in the anti-atherogenic effects of high-density lipoprotein (HDL-C) and may also be associated with symptomatic vulnerable plaques in carotid artery stenosis. Therefore, the present study investigated the relationship between apoA-I levels and the status of carotid artery stenosis.
Methods:
Ninety-one patients with carotid artery stenosis were examined. The status of carotid artery plaques was divided into symptomatic (n = 47) and asymptomatic (n = 44). We examined patient profiles, including comorbidities, and laboratory lipid data, and plaque features visualized by ultrasonography, MRI, and digital subtraction angiography. The relationships between plaque instability and risk factors for carotid artery stenosis were investigated.
Results:
No significant differences were observed in the profiles of symptomatic and asymptomatic patients. Regarding plaque features, ulceration, low echo luminance, and a high signal intensity in plaques on T1-weighted images correlated with symptomatic plaques. ApoA-I, total cholesterol, and non-HDL-C levels were significantly lower in symptomatic patients than in asymptomatic patients. A multivariate logistic regression analysis identified low ApoA-I levels, ulceration, and low echo luminance as predictive factors for symptomatic carotid artery stenosis. Diagnostic accuracy for predicting symptomatic carotid stenosis was 0.84 when the following four factors were combined: ulceration, low echo luminance, a high signal intensity on T1-weighted images, and the level of apoA-I.
Conclusions:
A low apoA-I level was associated with symptomatic carotid artery stenosis. Therefore, ApoA-I levels have potential as a surrogate marker to detect unstable carotid artery plaques.
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