Abstract 14989: Impact of Chronic Kidney Disease on Coronary Atherosclerotic Plaque in Patients with Metabolic Syndrome
Background: Chronic kidney disease (CKD) has emerged as a major atherosclerotic risk factor and is associated with metabolic syndrome. However, synergistic effects of these two risk factors on coronary lesions remain unclear. This study sought to determine lipid volume of coronary atherosclerotic plaques in subjects with clustering risk factors by integrated backscatter intravascular ultrasound (IB-IVUS).
Methods: Conventional and IB-IVUS using 40-MHz (motorized pullback 0.5mm/s) intravascular catheter was performed to 206 patients with 289 obstructive coronary lesions. The percentage of lipid area were automatically calculated by IB-IVUS system. Three-dimensional analysis of IB-IVUS was performed to determine the percentage of lipid volume (% LV). Glomerular filtration rate was estimated (eGFR) using the simplified Modification of Diet in Renal Disease Study equation. CKD was then defined as eGFR <60 ml/min/1.73 m2. Following the National Cholesterol Education Program Adult Treatment Panel III guidelines, the subjects were classified into non-metabolic syndrome (MetS) without CKD (n=50, 67 lesions), non-MetS with CKD (n=36, 61 lesions), MetS without CKD (n=68, 92 lesions) and MetS with CKD (n=52, 69 lesions).
Results: Mets with CKD was significantly associated with the greater plaque volume (p=0.0002) and % LV (p=0.006). On linear regression analysis, eGFR was significantly correlated with total plaque volume (r=-0.21, p=0.0003), while there was no significant correlation between eGFR and plaque contents (% LV). After adjusting for confounding factors, MetS with CKD was significantly associated with greater plaque volume with lipid-rich content (odds ratio=2.63, 95% confidence interval, 1.37 to 5.08, p=0.004).
Conclusions: MetS with CKD is an independent predictor of both large plaque volume and lipid-rich plaque.Coronary plaque volume is synergistically increased in MetS with CKD in negative correlation with eGFR. On the other hand, lipid-rich plaque volume is also synergistically increased in MetS with CKD regardless of eGFR. These results may imply that even though CKD stage is earlier, lipid-rich plaque volume is increased when MetS is accompanied with CKD.
- © 2011 by American Heart Association, Inc.