Rationale of decreasing low-density lipoprotein cholesterol below 70 mg/dL in patients with coronary artery disease: A retrospective virtual histology. Intravascular ultrasound study.

BACKGROUND: The associations between statin and coronary plaque compositional changes were reported according to the use of high dose or not. An evaluation of the impact of low-density lipoprotein cholesterol (LDL-C) < 70 mg/dL by using real world dosages of statin on coronary plaque composition was undertaken.

METHODS: The study subjects consisted of 61 patients (mean 59.9 years old, 45 males) who underwent percutaneous coronary intervention, baseline and follow-up (F/U; mean 8.4 months) virtual histology-intravascular ultrasound (VH-IVUS) examination. Change of plaque composition at peri-stent area, which was selected in order to measure the identical site at F/U study, was compared according to the F/U LDL-C level.

RESULTS: Body mass index, prevalence of dyslipidemia, baseline total cholesterol and baseline LDL-C were significantly lower in F/U LDL-C < 70 mg/dL group (14 segments in 10 patients) than F/U LDL-C  70 mg/dL group (79 segments in 51 patients). F/U high-density lipoprotein cholesterol (HDL-C, OR 1.06, 95% CI 1.00-1.11, p = 0.054) and F/U LDL-C < 70 mg/dL (OR 3.43, 95% CI 0.97-12.17, p = 0.056) showed strong tendency of regression of necrotic core volume (NCV) ≥ 10%. In multivariable logistic regression analysis, F/U HDL-C (OR 1.07, 95% CI 1.01-1.14, p = 0.020) and F/U LDL-C level < 70 mg/dL (OR 8.02, 95% CI 1.58-40.68, p = 0.012) were the independent factors for regression of NCV  10%.

CONCLUSIONS: F/U LDL-C level < 70 mg/dL with any types of statins and increase of HDL-C were associated with regression of NCV  10% in patients with coronary artery disease.