Abstract 14105: An Increase in the Serum High-density Lipoprotein Cholesterol Level May be a Better Predictor of Coronary Plaque Regression in Japanese Subjects: Evaluation by Receiver Operating Characteristic Analysis
Background: The level of serum low-density lipoprotein cholesterol (LDL-C) achieved and change in serum LDL-C level in response to statin therapy may not be reflected in coronary plaque regression in Japanese subjects, and plaque regression has occurred in many cases in the absence of any marked decrease in the serum LDL-C level. We hypothesized that the indicators of coronary plaque regression in response to statin therapy in a Japanese population are different from the indicators in Western populations.
Methods and Results: A 6-month prospective study to identify predictors of regression of coronary plaque as assessed by volumetric intravascular ultrasound was conducted on 114 coronary artery disease patients receiving pravastatin. After 6 months of therapy, the average change in plaque volume was -9.9% (p<0.0001, vs. baseline). Body mass index (BMI) before pravastatin therapy was significantly lower in the plaque regression group than in the plaque progression group (23.5±2.8 kg/m2 vs. 25.3±2.5 kg/m2, p<0.01). Furthermore, significant increases in the serum levels of high-density lipoprotein cholesterol (HDL-C) and apolipoprotein (apo) A-1, and decreases in the LDL-C/HDL-C, the apo B/apo A-1, and monocyte count were observed in the plaque regression group (n=90) in comparison with the plaque progression group (n=23). The changes in plaque volume correlated with the changes in the serum levels of HDL-C (r=-0.496, p<0.0001), the LDL-C/HDL-C (r=0.361, p<0.0001), apo A-1 (r=-0.362, p=0.0005), the apo B/apo A-1 (r=0.314, p=0.0003), the monocyte count (r=0.325, p=0.0004), and with the baseline BMI (r=0.278, p=0.003), but not with the change in LDL-C level (r=0.023, p=0.860). Moreover, a receiver operating characteristic (ROC) analysis showed that the change in HDL-C level proved better than any other parameters in terms of evaluating the predictor of plaque regression because of it had a larger the area under the ROC curve (0.751).
Conclusions: The results suggest that the ameliorating action of statin on lipid metabolism and sensitivity to their inhibitory effect on the progression of coronary plaque in the Japanese population and Western populations may be different. It may be necessary to devise a new statin treatment strategy for Japanese patients.
- © 2010 by American Heart Association, Inc.