The relation between extent of coronary artery disease measured by quantitative coronary angiography and changes in lipid profile: insights from trials of atherosclerosis regression.
ABSTRACT While favorable changes in atherogenic lipids are indisputably associated with improved clinical outcomes, a similar correlation with quantitative coronary angiography (QCA) parameters is more difficult to document.
To assess the relation between changes in lipid profile and parameters of coronary artery disease (CAD) extent measured by QCA.
We evaluated 1,315 patients enrolled in trials of atherosclerosis regression and correlated their lipid profile with annualized changes in CAD score (average minimal lumen diameter for all segments evaluated), cumulative stenosis score (sum of stenoses for all segments evaluated) and average plaque area for all segments evaluated.
During the study, average low-density lipoprotein (LDL) decreased by 28% (p < 0.001), and average high-density lipoprotein (HDL) increased by 8% (p < 0.001). There was no statistical correlation between annualized changes in CAD score and change in LDL (p = 0.31) or % change in LDL (p = 0.53). There was also no statistically significant correlation between change in cumulative stenosis score and change in LDL (p = 0.20) or % change in LDL (p = 0.10). Neither of these parameters of CAD extent correlated with the summation of % changes in LDL and HDL (p = 0.80 and p = 0.34, respectively). Patients with CAD regression (i.e., greater average MLD at follow up, n = 756) had similar LDL, HDL and C-reactive protein levels while on therapy as patients with CAD progression (n = 555).
Detailed analysis of CAD extent by QCA did not reveal a significant association with changes in lipid profile. These findings challenge the use of QCA as a surrogate endpoint for the effect of antiatherosclerotic therapy.
- SourceAvailable from: M K Garg[Show abstract] [Hide abstract]
ABSTRACT: Background:South Asians are more prone to develop metabolic syndrome (MetS). The additive predictive value of components of MetS for cardiovascular diseases is still debated. We undertook this study to evaluate the association of MetS and its components with severity of coronary artery disease (CAD). Materials and Methods:Three hundred patients with known coronary disease above the age of 25 years were included in this study. Blood samples were collected for biochemical markers. Patients were stratified into subjects with and without MetS (International Diabetes Federation, IDF, criteria) and severity of CAD (number of vessel involved). Results:Mean age of the patient in the study was 60.9 ± 12.4 years (male, M: 72%; female, F: 28%). MetS was present in 64% patients. Patients with MetS had more severe CAD compared to those without MetS. Triple vessel disease (TVD) was present in 62.5% of patients with MetS compared to 34.3% among without MetS (P < 0.0001). The percent number of patients with TVD showed increasing trend with increasing number of components of MetS (0-0%; 1-20%; 2-27.5%; 3-47.8%; 4-72.6%; 5-78.3%; Chi square for trend <0.0001). Inflammatory markers [interleukin (IL) 6: 77.67 ± 79.48 vs. 41.21 ± 60.72 pg/ml,P < 0.0001; tumor nuclear factor (TNF)-α: 28.0 ± 47.49 vs 20.43 ± 24.5 pg/ml,P < 0.0001; high sensitive C‑reactive protein (hsCRP): 14.30 ± 9.91 vs. 7.02 ± 7.18 mg/L,P < 0.0001], insulin resistance [homeostatic model analysis insulin resistance (HOMA‑IR): 22.33 ± 23.37 vs. 10.86 ± 13.90,P < 0.0001] were higher and insulin sensitivity [quantitative insulin check index (QUICKI): 0.26 ± 0.03 vs. 0.30 ± 0.04,P < 0.0001] was significantly lower in subjects with MetS compared to subjects without MetS. Among lipids, total cholesterol were comparable but triglyceride (175 ± 42 vs. 179 ± 48 vs. 180 ± 47 mg/dl,P < 0.0001) was high and high‑density lipoprotein (HDL; 44.72 ± 7.63 vs. 39.96 ± 8.70 vs. 36.05 ± 8.84, P < 0.0001) was low in subjects with TVD compared to others. Similarly, percentage of patients with diabetes (7.5% vs. 26.3% vs. 63.7%,P < 0.0001) and hypertension (34.3% vs. 56.6% vs. 77.7%,P < 0.0001) were higher in subjects with TVD compared to others. Conclusions:There is a strong correlation of MetS and its components with severity of CAD.09/2014; 18(5):708-14. DOI:10.4103/2230-8210.139238