Low-Density Lipoprotein and Noncalcified Coronary Plaque Composition in Patients With Newly Diagnosed Coronary Artery Disease on Computed Tomographic Angiography

Am J Cardiol. 2010; 105(6):761-766

Cheng VY, Wolak A, Gutstein A, Gransar H, Wong ND, Dey D, Thomson LE, Hayes SW, Friedman JD, Slomka PJ, Berman DS

OBJECTIVES: We sought to determine significant relations between atherogenic lipoproteins and the contribution of calcified plaque (CP), mixed plaque (MP), and noncalcified plaque (NCP) to the total plaque (TP) burden in patients without previous coronary artery disease.

METHODS: From 823 adult patients without previously established coronary artery disease (52% receiving statin therapy, 34% asymptomatic) but with visible coronary plaque on coronary computed tomographic angiography, we obtained segmental CP, MP, NCP, and TP counts from contrast-enhanced, electrocardiographic-gated computed tomography. Multivariate linear regression analysis was used to determine the associations of clinical factors and lipoprotein levels to CP, MP, and NCP counts and CP/TP, MP/TP, and NCP/TP count ratios.

RESULTS: Age, male gender, diabetes, smoking, and statin therapy were significantly associated with the CP count (p <0.001, p <0.001, p = 0.049, p = 0.016, and p = 0.003, respectively). Low-density lipoprotein (LDL) cholesterol was significantly associated with MP and NCP counts (all p values <0.002). LDL cholesterol was also the only variable to demonstrate significant concurrent relations with CP/TP, MP/TP, and NCP/TP ratios, including an inverse association with CP/TP (p = 0.008) and a positive association with MP/TP (p = 0.032). Analyses using non-high-density lipoprotein cholesterol in place of LDL cholesterol yielded similar results.

CONCLUSIONS: In conclusion, among the traditional clinical factors used to estimate cardiovascular event risk, LDL cholesterol is associated with an increased MP and NCP burden and is the sole variable that independently predicted relative predominance of CP, MP, and NCP, suggesting a potentially important role for lipoprotein levels in modulating the type of detectable coronary arterial plaque.

PMID: 20211316

2 Responses

  1. Ronen Rubinshtein, MD  on March 22nd, 2010

    This article gives more insight into the relationship between the level of atherosclerotic markers (specifically LDL cholesterol in this study) and coronary plaque burden and composition.

  2. Jacobo Kirsch, MD  on March 29th, 2010

    Very interesting study, which I found very well written and enjoyable to read! I thought the following observations very intriguing: “Cigarette smoking, age, and diabetes were not significantly associated with the relative plaque composition in our study. Our population was most likely underpowered for smoking analysis, because the active smoking rate was quite low (10%). Age and diabetes might promote atherogenic processes that affect all coronary plaque types at similar rates, preserving each plaque type’s relative contribution to the TP burden.” I was very surprised that smoking had no significant association with plaque burden even in a small percentage of patients (10% is still 83 patients! not such a small group!).


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