Abstract 15095: High-Risk Coronary Plaque Characteristics as Measured by Coronary Computed Tomography Angiography Have the Strongest Association with Low Plasma HDL

Abstract

Background: High risk plaque characteristics can be measured by coronary computed tomography angiography (CCTA) and have been associated with increased adverse cardiac event risk.

Methods: 374 asymptomatic patients in the High Risk Plaque study were evaluated using CCTA. Using a 16-segment convention for the coronary tree, the presence of high positive remodeling index (defined as ≥2 segments per patient with positive remodeling), obstructive coronary artery disease (CAD) (defined as presence of plaque with ≥50% stenosis), low-intermediate plaque attenuation (PA) (<150 Hounsfield units (HU), were associated with plasma lipids such as cholesterol, HDL, LDL, triglycerides and total cholesterol/HDL ratio. Presence of at least two of the above high risk features defined a two feature positive plaque.

Results: Of 374 patients, 60 had no plaques. Among 314 patients with presence of plaque 142 patients had at least one two high risk feature positive plaque. 209 patients had high positive remodeling, 107 had obstructive CAD, 52 had predominance (≥50%) of non-calcified plaque and 103 had low- intermediate PA plaques. Patients with presence of two high risk feature positive plaque had significantly lower levels of HDL (50.64 ±13.76 vs 60.06 ±17.30, p<0.001), higher levels of triglycerides (172.11 ±105.12 vs 135.46 ±73.37, p<0.05), higher total cholesterol/HDL ratio (4.17 ±1.23 vs 3.69 ±1.07, p<0.05) compared with patients with no plaque (figure). Plasma cholesterol and LDL were similar between different risk plaque categories. Similar results for the individual high risk CTA characteristics.In multivariable analysis, HDLremained an important predictor of two high risk feature plaque (OR=0.972, p<0.05), high positive remodeling (OR=0.980, p<0.05) and obstructive CAD (OR=0.970, p<0.05) in contrast to other lipids.

Conclusion: Compared with other lipids, plasma HDL has the strongest association with higher risk plaque as identified by CCTA.