The Role and Assessment of Lipid Profile in Patients With a Chronic Total Coronary Occlusion

Adequate lipid management is a crucial component in the treatment of chronic coronary syndromes, a group of conditions that also encompasses patients with chronic total coronary occlusions (CTOs). Importantly, atherosclerotic progression may be especially rapid in patients with a CTO, yet it is unknown whether specific lipid thresholds for this population are appropriate or need to be adjusted compared to non-CTO patients. The present review aimed to provide insight into the lipid profiles of CTO patients and their association with clinical outcome compared to non-CTO patients. Furthermore, we investigated the impact of lipid levels on coronary collateral circulation (CCC) development. The available data suggest a tendency towards a more adverse lipid profile in CTO patients compared with non-CTO patients, characterized by elevated TG, Lp(a), and AIP, and reduced HDL levels. While lipid parameters are frequently reported as baseline characteristics, few studies have directly evaluated their prognostic significance. The current evidence supports the hypothesis that a greater atherogenic burden in CTO patients may be associated with worse clinical outcomes and poorer CCC formation, particularly when advanced lipidomic markers or composite indices are considered. If confirmed in larger prospective studies, incorporating a more comprehensive assessment of the lipid profile into the clinical management of CTO patients may improve risk stratification and provide a basis for more personalized lipid-lowering strategies in this high-risk population.