Highlights
- •OCT assessed neoatherosclerosis (NA) in statin-treated patients.
- •TG-rich lipoprotein (TRL) levels were significantly higher in the NA group.
- •Apolipoprotein (apo) C3, TRL-C, and apoB levels were risk factors for NA
- •LDL-C levels were similar in the NA and non-NA group.
Background
Neoatherosclerosis (NA), which refers to neointimal atherosclerosis within a stent,
is considered one of the underlying causes of late-phase stent failure following a
newer generation drug-eluting stent (DES) placement procedure. Even contemporary guideline-directed
medical therapy may be insufficient to prevent NA.
Objective
This study aimed to investigate how intricately lipid markers are associated with
NA formation in the early phase of treatment with well-maintained low-density lipoprotein
cholesterol (LDL-C) levels.
Methods
We enrolled 114 consecutive patients undergoing statin treatment and percutaneous
coronary intervention (PCI) with current-generation DES for coronary artery disease.
At a median 12 months after PCI, optical coherence tomography (OCT) was performed.
Various lipid markers, including LDL-C, triglyceride (TG), triglyceride-rich lipoprotein
cholesterol (TRL-C), non-high-density lipoprotein cholesterol (non-HDL-C), malondialdehyde-modified
LDL (MDA-LDL), and several apolipoproteins, were also evaluated.
Results
NA was observed in 17 (14.9%) patients. The LDL-C level was equivalent in patients
with or without NA (77.2 vs. 69.8 mg/dL; p=0.15). However, the levels of TG, apolipoprotein
C3 (apoC3), TRL-C, non-HDL-C, and apolipoprotein B (apoB), and MDA-LDL were significantly
higher in the patients with NA. Furthermore, multivariate logistic regression adjusting
for HbA1c and stent duration revealed apoC3, TRL-C, non-HDL-C, apoB, and MDA-LDL levels
as risk factors for NA. However, when apoB was included as a covariate, other factors
became nonsignificant.
Conclusions
Abnormal triglyceride-rich lipoprotein metabolism and high atherogenic apoB-containing
lipoprotein particle numbers are associated with the formation of NA in patients undergoing
statin treatment at a median 12 months post-PCI.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
AA (indicates Arachidonic acid), ACS (Acute coronary syndrome), Apo (Apolipoprotein), AUC (Area under the curve), CAD (Coronary artery disease), CI (Confidence interval), DES (Drug eluting stent), eGFR (estimated glomerular filtration rate), EPA (Eicosapentaenoic acid), HbA1c (Glycated hemoglobin), HDL-C (High-density lipoprotein-cholesterol), Hs-CRP (High-sensitivity C-reactive protein), LDL-C (Low-density lipoprotein-C), MACE (Major adverse cardiovascular event), MDA-LDL (Malondialdehyde-modified low-density lipoprotein), NA (Neoatherosclerosis), Non-HDL-C (Non-high-density lipoprotein cholesterol), NT-proBNP (N-terminal pro-brain natriuretic peptide), OCT (Optical coherence tomography), OR (Odds ratio), PCI (Percutaneous coronary intervention), Sd-LDL-C (Small dense LDL-C), TG (Triglyceride), TRL-C (Triglyceride-rich lipoprotein-cholesterol), TRLs (Triglyceride-rich lipoproteins)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 26, 2023
Accepted:
January 15,
2023
Received:
June 21,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Ethics approval and consent to participate: Written informed consent was obtained from all individuals, and the local ethics committee approved the protocol.
Consent for publication: Not applicable.
Availability of data and materials: The raw data will not be shared as the participants did not consent to this.
Author's contributions: RS, TS, and SK (Shinji Koba) contributed to the study design, manuscript preparation, data analysis, data interpretation, and critical revisions of the manuscript. TA, NM, YY, SS, HT (Hideaki Tanaka), and RM contributed to data acquisition and analysis. YO, KO, KA, KN, KS, HT (Hiroaki Tsujita), SK (Seita Kondo), and ST contributed to data acquisition. HM contributed to data analysis and interpretation. HS and TS (Toshiro Shinke) contributed to the data interpretation, critical revisions, and editing of the manuscript.
Declaration of competing interest: Shinji Koba and Toshiro Shinke received research funding from Denka Seiken Co., Ltd. and Abbott Medical. The other authors have no conflicts of interest to declare.
Funding: Shinji Koba and Toshiro Shinke received research funding from Denka Seiken Co., Ltd. and Abbott Medical. The funders had no role in this study.
Identification
Copyright
© 2023 National Lipid Association. Published by Elsevier Inc. All rights reserved.
