Lipoprotein (a) level is associated with plaque vulnerability in patients with coronary artery disease: An optical coherence tomography study

Yusuke Muramatsu, Yoshiyasu Minami, Ayami Kato, Aritomo Katsura, Toshimitsu Sato, Ryota Kakizaki, Teruyoshi Nemoto, Takuya Hashimoto, Kazuhiro Fujiyoshi, Kentaro Meguro, Takao Shimohama, Junya Ako, Yusuke Muramatsu, Yoshiyasu Minami, Ayami Kato, Aritomo Katsura, Toshimitsu Sato, Ryota Kakizaki, Teruyoshi Nemoto, Takuya Hashimoto, Kazuhiro Fujiyoshi, Kentaro Meguro, Takao Shimohama, Junya Ako

Abstract

Background: High lipoprotein (a) [Lp(a)] levels are an independent factor for worse prognosis in patients with coronary artery disease (CAD). However, the association between serum Lp(a) level and coronary plaque vulnerability remains to be determined.

Methods: A total of 255 consecutive patients with CAD who underwent optical coherence tomography imaging of culprit lesions were included. Patients were divided into 2 groups according to their Lp(a) levels (the higher Lp(a) group [≥25 mg/dL], n = 87; or the lower Lp(a) group [<25 mg/dL], n = 168).

Results: The prevalence of thin-cap fibroatheroma (TCFA) was significantly higher in the higher Lp(a) group than in the lower Lp(a) group (23% [n = 20] vs. 11% [n = 19], p = 0.014). Although the prevalence of TCFA was comparable between the 2 groups among patients with a lower LDL cholesterol (LDL-C) level (<100 mg/dL), TCFA was significantly more prevalent in the higher Lp(a) group than in the lower Lp(a) group (39% [14/36] vs. 10% [5/50], p = 0.001) among patients with a higher LDL-C level (≥100 mg/dL).

Conclusions: A higher Lp(a) level was associated with a higher frequency of TCFA, particularly in patients with a higher LDL-C level.

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
ROC analysis for the presence of OCT-TCFA. A, All patients; B, patients with LDL-C ≥100 mg/dL. AUC, area under the curve; LDL-C, low-density lipoprotein cholesterol; ROC, receiver operator characteristics; OCT-TCFA, thin-cap fibroatheroma on OCT images.
Fig. 2
Fig. 2
Representative images of lipid-rich plaque. A, OCT-TCFA in patients with Lp(a) ≥25 mg/dL; B, lipid-rich plaque without OCT-TCFA in patients with Lp(a)

Fig. 3

Prevalence of OCT-TCFA according to…

Fig. 3

Prevalence of OCT-TCFA according to Lp(a) values. OCT-TCFA, thin-cap fibroatheroma on OCT images.

Fig. 3
Prevalence of OCT-TCFA according to Lp(a) values. OCT-TCFA, thin-cap fibroatheroma on OCT images.

Fig. 4

Prevalence of OCT-TCFA according to…

Fig. 4

Prevalence of OCT-TCFA according to Lp(a) and LDL-C levels. LDL-C, low-density lipoprotein cholesterol;…

Fig. 4
Prevalence of OCT-TCFA according to Lp(a) and LDL-C levels. LDL-C, low-density lipoprotein cholesterol; OCT-TCFA, thin-cap fibroatheroma on OCT images; NS, not significant.
Fig. 3
Fig. 3
Prevalence of OCT-TCFA according to Lp(a) values. OCT-TCFA, thin-cap fibroatheroma on OCT images.
Fig. 4
Fig. 4
Prevalence of OCT-TCFA according to Lp(a) and LDL-C levels. LDL-C, low-density lipoprotein cholesterol; OCT-TCFA, thin-cap fibroatheroma on OCT images; NS, not significant.

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