Impact of triglyceride-rich lipoproteins on early in-stent neoatherosclerosis formation in patients undergoing statin treatment

J Clin Lipidol. 2023 Mar-Apr;17(2):281-290. doi: 10.1016/j.jacl.2023.01.004. Epub 2023 Jan 26.

Abstract

Background: Neoatherosclerosis (NA), which refers to neointimal atherosclerosis within a stent, is considered one of the underlying causes of late-phase stent failure following a newer generation drug-eluting stent (DES) placement procedure. Even contemporary guideline-directed medical therapy may be insufficient to prevent NA.

Objective: This study aimed to investigate how intricately lipid markers are associated with NA formation in the early phase of treatment with well-maintained low-density lipoprotein cholesterol (LDL-C) levels.

Methods: We enrolled 114 consecutive patients undergoing statin treatment and percutaneous coronary intervention (PCI) with current-generation DES for coronary artery disease. At a median 12 months after PCI, optical coherence tomography (OCT) was performed. Various lipid markers, including LDL-C, triglyceride (TG), triglyceride-rich lipoprotein cholesterol (TRL-C), non-high-density lipoprotein cholesterol (non-HDL-C), malondialdehyde-modified LDL (MDA-LDL), and several apolipoproteins, were also evaluated.

Results: NA was observed in 17 (14.9%) patients. The LDL-C level was equivalent in patients with or without NA (77.2 vs. 69.8 mg/dL; p=0.15). However, the levels of TG, apolipoprotein C3 (apoC3), TRL-C, non-HDL-C, and apolipoprotein B (apoB), and MDA-LDL were significantly higher in the patients with NA. Furthermore, multivariate logistic regression adjusting for HbA1c and stent duration revealed apoC3, TRL-C, non-HDL-C, apoB, and MDA-LDL levels as risk factors for NA. However, when apoB was included as a covariate, other factors became nonsignificant.

Conclusions: Abnormal triglyceride-rich lipoprotein metabolism and high atherogenic apoB-containing lipoprotein particle numbers are associated with the formation of NA in patients undergoing statin treatment at a median 12 months post-PCI.

Keywords: Apolipoptotein B; Apolipoptotein C3; Neoatherosclerosis; Non-high-density lipoprotein cholesterol; Optical coherence tomography; Triglyceride-rich lipoprotein cholesterol.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Apolipoproteins B
  • Atherosclerosis* / etiology
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Drug-Eluting Stents* / adverse effects
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / pharmacology
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
  • Lipoproteins / metabolism
  • Percutaneous Coronary Intervention* / adverse effects
  • Stents / adverse effects
  • Triglycerides

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Cholesterol, LDL
  • Lipoproteins
  • Triglycerides
  • Apolipoproteins B
  • Cholesterol, HDL