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Increased macrophage activity in coronary plaques in patients with acute coronary syndrome and familial
Toshiyuki Iwaya1, Yoshiyasu Minami1, Kiyoshi Asakura1
1Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Insights
Familial hypercholesterolemia (FH) patients with acute coronary syndrome (ACS) show more coronary plaques with macrophages, especially in non-culprit segments. This finding may explain their higher risk of recurrent cardiovascular events.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
- Genetics and Lipid Metabolism
Background:
- Familial hypercholesterolemia (FH) significantly increases the risk of premature acute coronary syndrome (ACS) and recurrent cardiovascular events.
- Understanding the specific plaque characteristics in FH patients is crucial for risk stratification and management.
Purpose of the Study:
- To investigate the morphological characteristics of coronary artery plaques, focusing on macrophage presence and activity, in patients with FH and ACS.
- To compare plaque features between patients with and without FH using optical coherence tomography (OCT).
Main Methods:
- A cohort of 259 ACS patients undergoing percutaneous coronary intervention received optical coherence tomography (OCT) imaging.
- Culprit and non-culprit coronary plaques were analyzed for macrophage content and activity in patients with and without FH.
- Statistical comparisons were made between the FH and non-FH groups.
Main Results:
- Patients with FH (8.9%) exhibited a numerically higher prevalence of macrophages in culprit plaques compared to non-FH patients.
- Significantly higher prevalence of macrophages and greater macrophage activity were observed in non-culprit plaques of FH patients.
- Non-culprit plaques in FH patients also showed a higher prevalence of layered plaque morphology.
Conclusions:
- Familial hypercholesterolemia patients with ACS present with a greater burden of coronary plaques containing macrophages, particularly in non-culprit segments.
- These findings suggest that enhanced macrophage activity in coronary plaques may contribute to the elevated risk of recurrent events observed in FH.
- OCT imaging provides valuable insights into plaque composition and its association with cardiovascular risk in FH.
Background:
Patients with familial hypercholesterolemia (FH) experience acute coronary syndrome (ACS) at a younger age and have a higher risk of recurrent coronary events. The study aimed to elucidate the morphological characteristics of coronary plaques including the status of macrophages in patients with FH.
Methods:
This study included 259 patients with ACS who underwent optical coherence tomography (OCT) imaging of culprit plaques requiring percutaneous coronary intervention. The characteristics of culprit plaques and non-culprit plaques in the same coronary artery were compared between patients with and without FH.
Results:
A total of 23 patients (8.9 %) were clinically diagnosed with FH. In culprit plaques, the prevalence of both plaque with macrophages (69.6 % vs. 49.6 %, p = 0.081) and plaque with greater macrophage activity (macrophage grade ≥2) (65.0 % vs. 43.9 %, p = 0.099) was numerically higher in patients with FH than in those without FH. In non-culprit plaques, the prevalence of both plaque with macrophages (71.4 % vs. 42.0 %, p = 0.046) and plaque with greater macrophage activity (42.9 % vs. 16.0 %, p = 0.021) was significantly higher in patients with FH than in those without FH. The higher prevalence of layered plaques (78.6 % vs. 37.8 %, p = 0.008) in patients with FH than in those without FH was observed in non-culprit plaques.
Conclusions:
FH patients with ACS had more coronary plaques with macrophages, particularly in non-culprit segments, which may partly explain the increased risk of recurrent coronary events.
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