Abstract 1558: Changes in Markers of Systemic Inflammation Predict Progression of Coronary Atherosclerosis in Patients With Abdominal Obesity
Background: The endocannabinoid receptor antagonist rimonabant was shown to not slow progression of percent atheroma volume (PAV) in abdominally obese patients with coronary artery disease. The impact of serial changes in clinical characteristics and atheroma progression has not been previously investigated.
Methods: The relationship between percentage changes and on-treatment levels of biochemical parameters and the changes in PAV, determined by serial intravascular ultrasound, were investigated in 676 abdominally obese patients with coronary artery disease who participated in the STRADIVARIUS study.
Results: PAV increased from 37.5 to 37.9% (p<0.001) over 18 months of follow-up. Rimonabant compared to placebo had a favorable impact on change in waist circumference (−4.5 vs −1.0cm, p<0.001), body mass index (−1.49 vs −0.25kg/m2, p<0.001), HDL-C (5.8 vs 1.8 mm/dL, p<0.001), triglycerides (−24.8 vs −8.9mg/dL, p<0.001), and percent change in adiponectin (26.6 vs 1.4%, p<0.001), leptin (−4.9 vs 2.3%, p=0.10), and CRP (50.3% and 30.9%, <0.001). Accelerated progression of PAV was observed in subjects with greater achieved levels of LDL-C (0.71 vs 0.05%, p=0.002), triglycerides (0.68 vs 0.10%, p=0.005), triglycerides/HDL-C (0.60 vs 0.17%, p=0.04), apoB/A-I (0.80 vs −0.03%, p<0.001) and CRP (0.67 vs 0.08%, p=0.004) and lower levels of HDL-C (0.12 vs 0.65%, p=0.01). Greater increases in HDL-C (0.17 vs 0.60%, p=0.04) was beneficial on PAV progression but, greater increases in triglycerides/HDL-C (0.57 vs 0.21%, p=0.09), apoB/A-I (0.56 vs 0.21 %, p=0.094) and CRP (0.80 vs −0.04%, p<0.0001) were detrimental. No relationship was observed between changes in levels of body mass index (r=0.06, p=0.10), waist circumference (r=0.06, p=0.13), adiponectin (−0.04, p=0.31) and leptin (−0.02, p=0.66) and progression of PAV. A Multivariable model revealed that an increase in CRP (p <0.001) independently predicted the extent of disease progression after controlling for baseline plaque burden, baseline LDL and use of beta-blockers or thiazolidinediones.
Conclusion: Changes in markers of systemic inflammation and atherogenic dyslipidemic markers predict progression of coronary atherosclerosis in patients with abdominal adiposity.