Low HDL cholesterol predicts culprit plaque rupture in ACS
MedWire News: Low levels of high-density lipoprotein (HDL) cholesterol and abdominal obesity are risk factors for culprit plaque rupture in patients with acute coronary syndromes (ACS), a Japanese team has shown.
Their finding comes from a study that used intravascular ultrasound (IVUS) to assess the clinical characteristics associated with vulnerable plaque rupture, as opposed to thrombus formation in lesions without plaque rupture.
They enrolled 110 consecutive patients with ACS who underwent emergent coronary angiography, 60 (55%) of whom were found to have culprit coronary plaque rupture.
Patients with plaque rupture tended to be younger (62.4 vs 67.1 years) and were more likely to be male (85% vs 66%) and have the metabolic syndrome (65% vs 34%) than those without rupture. They also had a higher average body mass index (25.1 vs 22.5 kg/m2), a larger waist circumference (87.1 vs 80.8 cm), and lower levels of HDL cholesterol.
IVUS analysis also revealed that the lesion remodeling index was greater in the rupture group.
In multivariate analysis, the strongest independent predictors of culprit coronary plaque rupture were the presence of the metabolic syndrome, Thrombolysis in Myocardial Infarction flow grade 0, elastic membrane cross-sectional area of at least 14 mm2, and positive remodeling at the culprit lesion, with adjusted odds ratios (ORs) of 5.26, 11.66, 6.42, and 3.82, respectively.
Among the components of metabolic syndrome, abdominal obesity and a low serum HDL cholesterol level were significant independent predictors of plaque rupture, with adjusted ORs of 2.98 and 2.94, respectively.
Masaya Kato (Hiroshima City Asa Hospital) and team say that understanding the different etiologies of ACS is important "to guide future prevention and delivery of optimal therapy."
They write in the Circulation Journal: "Not only the positive remodeling and large plaque burden, but also the large external elastic membrane cross-sectional area and luminal cross-sectional area were necessary for plaque ruptures. As a result, more massive thrombus formation might occur in ruptured culprit plaque."
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By Joanna Lyford