Elevated Lipoprotein(a) as a potential residual risk factor associated with lipid-rich coronary atheroma in patients with type 2 diabetes and coronary artery disease on statin treatment: Insights from the REASSURE-NIRS registry.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: Ireland NLM ID: 0242543 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1484 (Electronic) Linking ISSN: 00219150 NLM ISO Abbreviation: Atherosclerosis Subsets: MEDLINE
    • Publication Information:
      Publication: Limerick : Elsevier
      Original Publication: Amsterdam, Elsevier.
    • Subject Terms:
      Atherosclerosis* ; Coronary Artery Disease*/diagnostic imaging ; Coronary Artery Disease*/drug therapy ; Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/diagnosis ; Diabetes Mellitus, Type 2*/drug therapy ; Hydroxymethylglutaryl-CoA Reductase Inhibitors*/therapeutic use ; Percutaneous Coronary Intervention* ; Plaque, Atherosclerotic*; Cholesterol, LDL ; Disease Progression ; Humans ; Lipoprotein(a) ; Registries ; Risk Factors
    • Abstract:
      Background and Aims: The residual risk of atherosclerotic cardiovascular disease (ASCVD) in patients with diabetes on statin therapy warrants identification of other pro-atherogenic drivers. Lipoprotein(a) [Lp(a)] promotes the formation of necrotic cores within vessel walls. Given that patients with diabetes have an Lp(a)-associated ASCVD risk, Lp(a) might lead to plaque vulnerability in patients with diabetes on statin therapy.
      Methods: We analyzed target lesions that underwent PCI in 312 patients with coronary artery disease (CAD) on statin treatment from the REASSURE-NIRS registry (NCT04864171). Maximum 4-mm lipid-core-burden index (maxLCBI 4mm ) in target lesions was measured with near-infrared spectroscopy (NIRS) imaging. The relationship between Lp(a) levels and maxLCBI 4mm was investigated in patients with and without diabetes.
      Results: High-intensity statin use (p = 0.49) and on-treatment low-density lipoprotein cholesterol (LDL-C) (p = 0.32) and Lp(a) levels (p = 0.09) were comparable between patients with and without diabetes. Lp(a) levels were significantly associated with maxLCBI 4mm in patients with diabetes (p = 0.01) but not in patients without diabetes (p = 0.96). Multivariate analysis showed that LDL-C levels (p = 0.03) predict maxLCBI 4mm in patients without diabetes, but not Lp(a) levels (p = 0.91). Both LDL-C (p = 0.01) and Lp(a) (p = 0.04) levels were independent predictors of maxLCBI 4mm in patients with diabetes. Even in patients with diabetes achieving LDL-C <1.8 mmol/L (70 mg/dL), Lp(a) levels remained associated with maxLCBI 4mm (p = 0.04).
      Conclusions: A significant relationship between Lp(a) and maxLCBI 4mm exists in patients with diabetes and CAD on statin treatment, even with LDL-C <1.8 mmol/L (70 mg/dL). Lp(a) might be associated with more vulnerable coronary atheroma in patients with diabetes despite receiving statin therapy.
      (Copyright © 2022 Elsevier B.V. All rights reserved.)
    • Contributed Indexing:
      Keywords: LDL-C; Lipid-rich plaque; Lipoprotein (a); Near-infrared spectroscopy; Type 2 diabetes mellitus
    • Molecular Sequence:
      ClinicalTrials.gov NCT04864171
    • Accession Number:
      0 (Cholesterol, LDL)
      0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
      0 (Lipoprotein(a))
    • Publication Date:
      Date Created: 20220422 Date Completed: 20220525 Latest Revision: 20220607
    • Publication Date:
      20240628
    • Accession Number:
      10.1016/j.atherosclerosis.2022.03.033
    • Accession Number:
      35450750