Abstract 1460: Clinical Predictors of Atherosclerosis Progression in Patients With Very Low Levels of LDL Cholesterol
Background: Achieving low-density lipoprotein cholesterol (LDL-C) levels below 70 mg/dL promote regression of coronary atherosclerosis. The factors that underlie disease progression in some patients despite these favorable LDL-C levels are uncertain.
Methods: 3437 patients with coronary artery disease underwent serial intravascular ultrasound to monitor changes in atheroma burden in 7 clinical trials of anti-atherosclerotic therapies. Patients with an on-treatment follow-up LDL-C ≤70 mg/dL (n=951) were classified as progressors (≥5% increase in percent atheroma volume) or non-progressors. Clinical and biochemical characteristics of these groups were compared.
Results: Among patients with an on-treatment LDL-C ≤70 mg/dL (age 59.3±9.5 years, 73% male, 83% hypertension, 30% diabetes, 98% statin use) 21% underwent atheroma progression. Progressors demonstrated greater baseline levels of glucose (median, 104.0 vs. 99.9, p=0.02) and triglycerides (median, 157.5 vs. 133.0, p=0.004) and a smaller decrease in apolipoprotein B (LSMean±se, −25.1±3.4 vs. −27.4±3.35, p=0.01) compared with patients who did not demonstrate disease progression. Multivariable analysis revealed that independent predictors of disease progression included baseline plaque burden (p<0.0001), baseline LDL-C (p=0.003), diabetes (p=0.005) and the change in apoB (p=0.008), but not LDL-C (p=0.30) c-reactive protein (CRP, p=0.70).
Conclusions: Diabetes and suboptimal reductions in atherogenic lipid parameters predict atherosclerosis progression despite achieving very low LDL-C levels. The importance of apoB in patients with a LDL-C <70 mg/dL highlights the residual atherogenic potential of small, dense LDL particles in patients whose LDL-C appears to be well controlled.