Chonnam Med J.  2015 Dec;51(3):120-128. 10.4068/cmj.2015.51.3.120.

Predictors of Plaque Progression in Hypertensive Angina Patients with Achieved Low-Density Lipoprotein Cholesterol Less Than 70 mg/dL after Rosuvastatin Treatment

• Hong YJ
• Jeong MH
• Kim MC
• Kim WJ
• Kim HK
• Park KH
• Sim DS
• Kim JH
• Ahn Y
• Cho JG
• Park JC

• KMID: 2172128
• DOI: http://doi.org/10.4068/cmj.2015.51.3.120

Abstract

We evaluated the impact of achieved low-density lipoprotein cholesterol (LDL-C) concentrations <70 mg/dL on plaque progression in statin-treated hypertensive angina patients by use of virtual histology-intravascular ultrasound (VH-IVUS). The effects of 10 mg of rosuvastatin on plaque progression were evaluated in 78 patients who achieved LDL-C <70 mg/dL with statin treatment. The patients were divided into plaque progressors (n=30) and plaque regressors (n=40) on the basis of the baseline minimum lumen area (MLA) site at the 9-month follow-up. The prevalence of chronic kidney disease (CKD) [creatinine clearance (CrCl) <60 mL/min)] and current smoking was higher in progressors than in regressors (90.0% vs. 31.3%, p<0.001, and 40.0% vs. 12.5%, p=0.005, respectively). Baseline CrCl was significantly lower and baseline apolipoprotein (apo) B/A1 was significantly higher in progressors than in regressors (21+/-13 mL/min vs. 70+/-20 mL/min, p<0.001, and 0.77+/-0.23 vs. 0.65+/-0.16, p=0.011, respectively). Absolute and relative fibrotic areas at the MLA site increased in progressors; by contrast, these areas decreased in regressors from baseline to follow-up. CKD [odds ratio (OR): 2.13, 95% confidence interval (CI): 1.77-2.53, p=0.013], smoking (OR: 1.76, 95% CI: 1.23-2.22, p=0.038), and apoB/A1 (OR: 1.25, 95% CI: 1.12-1.40, p=0.023), but not any VH-IVUS parameters, were independent predictors of plaque progression at follow-up. In conclusion, clinical factors including CKD, smoking, and apoB/A1 rather than plaque components detected by VH-IVUS are associated with plaque progression in hypertensive angina patients who achieve very low LDL-C after statin treatment.

Keyword

Coronary disease; Hypertension; Plaque; Lipids; Ultrasonography, Interventional

MeSH Terms

Apolipoproteins
Cholesterol*
Coronary Disease
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypertension
Lipoproteins*
Prevalence
Renal Insufficiency, Chronic
Smoke
Smoking
Ultrasonography
Ultrasonography, Interventional
Rosuvastatin Calcium
Apolipoproteins
Cholesterol
Lipoproteins
Smoke

Figure

• 

  FIG. 1 Representative case of plaque progression from baseline to the 9-month follow-up in a patient with hypertension who presented with unstable angina and whose achieved low-density lipoprotein cholesterol level was 58 mg/dL: (A) baseline coronary angiography, (B) follow-up coronary angiography, (C) baseline virtual histology-intravascular ultrasound, (D) follow-up virtual histology-intravascular ultrasound.

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