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Characterization of lipidic plaque features in association with LDL-C<70 mg/dL and lipoprotein(a) <50 mg/dL
Daisuke Shishikura1, Yu Kataoka2, Stephen J Nicholls3
1Osaka Medical and Pharmaceutical University, Department of Cardiology, Japan (Drs Shishikura, Kusumoto, Yamauchi, Sakane, Fujisaka, Morita, Harada-Shiba, Hoshiga).
Insights
Lowering lipoprotein(a) [Lp(a)] alongside low-density lipoprotein cholesterol (LDL-C) may stabilize coronary atherosclerosis. Achieving both LDL-C <70 mg/dL and Lp(a) <50 mg/dL significantly reduces plaque lipid burden in patients with coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
- Medical Imaging
Background:
- Residual cardiovascular risk persists despite LDL-C reduction, necessitating identification of additional atherosclerosis drivers.
- Circulating lipoprotein(a) [Lp(a)] is proatherogenic, promoting foam cell formation.
- The impact of combined low Lp(a) and controlled LDL-C on plaque stability is not well understood.
Purpose of the Study:
- To investigate the effect of achieving both LDL-C <70 mg/dL and Lp(a) <50 mg/dL on coronary plaque characteristics using near-infrared spectroscopy (NIRS).
- To assess whether this combined lipid control influences the lipid core burden index (MaxLCBI4mm) in patients with coronary artery disease (CAD).
Main Methods:
- Analysis of 439 patients with CAD from the REASSURE-NIRS registry undergoing percutaneous coronary intervention.
- Comparison of clinical characteristics and NIRS-derived MaxLCBI4mm across four groups defined by LDL-C (70 mg/dL) and Lp(a) (50 mg/dL) levels.
- Multivariable logistic regression to determine the association between combined lipid control and high plaque lipid burden (MaxLCBI4mm ≥400).
Main Results:
- 33.4% of patients achieved both LDL-C <70 mg/dL and Lp(a) <50 mg/dL, exhibiting a higher male proportion and lower acute coronary syndrome frequency.
- Patients with both lipid goals met had significantly lower MaxLCBI4mm (P<.001) and reduced frequency of MaxLCBI4mm ≥400 (P=.001).
- Combined LDL-C <70 mg/dL and Lp(a) <50 mg/dL was associated with a ~70% lower risk of high plaque lipid burden (aOR: 0.30; 95% CI: 0.13-0.68).
Conclusions:
- Circulating Lp(a) is a potential therapeutic target for stabilizing coronary atherosclerosis.
- Achieving LDL-C <70 mg/dL in conjunction with Lp(a) <50 mg/dL is linked to reduced lipid core burden in CAD patients.
- These findings highlight the importance of managing both LDL-C and Lp(a) for cardiovascular risk reduction.
Background:
The ongoing residual cardiovascular risks despite lowering low-density lipoprotein cholesterol (LDL-C) levels suggest the need to identify additional drivers associated with atherosclerosis. Circulating lipoprotein(a) [Lp(a)] promotes formation of foam cells via its proatherogenic properties. However, whether a lower Lp(a) level in combination with favorable LDL-C control could induce a more stable form of disease remains unknown. Near-infrared spectroscopy (NIRS) generates maximum lipid-core burden index in 4 mm (MaxLCBI4 mm) which is a histologically validated measure of lipidic plaque material in vivo. Therefore, the current study employed NIRS imaging to characterize lipidic plaque in association with LDL-C < 70 mg/dL and Lp(a) <50 mg/dL.
Methods:
We analyzed 439 patients with coronary artery disease (CAD) (554 de-novo target lesions receiving percutaneous coronary intervention) in the REASSURE-NIRS registry (NCT04864171). Clinical characteristics and NIRS-derived MaxLCBI4mm were compared among 4 groups according to LDL-C of 70 mg/dL and Lp(a) of 50 mg/dL.
Results:
Almost one-third of study subjects (33.4%) exhibited both LDL-C < 70 mg/dL and Lp(a) <50 mg/dL. They were more likely male with a lower frequency of acute coronary syndrome and lipid lowering therapies were more frequently used in those with LDL-C < 70 mg/dL and Lp(a) <50 mg/dL. On NIRS imaging analysis, a smaller MaxLCBI4mm (P < .001) and a lower frequency of MaxLCBI4mm ≥400 (P = .001) were observed in those with both LDL-C < 70 mg/dL and Lp(a) <50 mg/dL. On multivariable logistic regression analysis, the coexistence of these 2 lipid controls showed an approximately 70% lower risk (adjusted odds ratio: 0.30; 95% CI: 0.13-0.68) of MaxLCBI4mm ≥400 compared with the reference group (LDL-C ≥ 70 mg/dL and Lp(a) ≥50 mg/dL).
Conclusion:
Our findings suggest circulating Lp(a) as a potential therapeutic target to stabilize coronary atherosclerosis in CAD patients who achieved LDL-C < 70 mg/dL.
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