Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.
School of Medicine, National Yang-Ming University.
J Atheroscler Thromb. 2020 Aug 1;27(8):789-800. doi: 10.5551/jat.51425. Epub 2019 Dec 27.
Coronary atherosclerotic plaques can be detected in asymptomatic subjects and are related to low-density lipoprotein cholesterol (LDL) levels in patients with coronary artery disease. However, researchers have not yet determined the associations between various plaque characteristics and other lipid parameters, such as HDL-C and TG levels, in low-risk populations.
One thousand sixty-four non-diabetic subjects (age, 57.86±9.73 years; 752 males) who underwent coronary computed tomography angiography (CCTA) were enrolled and the severity and patterns of atherosclerotic plaques were analyzed.
Statin use was reported by 25% of the study population, and subjects with greater coronary plaque involvement (segment involvement score, SIS) were older and had a higher body mass index (BMI), blood pressure, unfavorable lipid profiles and comorbidities. After adjusting for comorbidities, only age (β=0.085, p＜0.001), the male gender (β=1.384, p＜0.001), BMI (β=0.055, p=0.019) and HbA1C levels (β=0.894, p＜0.001) were independent factors predicting the greater coronary plaque involvement in non-diabetic subjects. In the analysis of significantly different (＞50%) stenosis plaque patterns, age (OR: 1.082, 95% CI: 10.47-1.118) and a former smoking status (OR: 2.061, 95% CI: 1.013-4.193) were independently associated with calcified plaques. For partial calcified (mixed type) plaques, only age (OR: 1.085, 95% CI: 1.052-1.119), the male gender (OR: 7.082, 95% CI: 2.638-19.018), HbA1C levels (OR: 2.074, 95% CI: 1.036-4.151), and current smoking status (OR: 1.848, 95% CI: 1.089-3.138) were independently associated with the risk of the presence of significant stenosis in mixed plaques.
A higher HbA1c levels is independently associated with the presence and severity of coronary artery atherosclerosis in non-diabetic subjects, even when LDL-C levels are tightly controlled.
在无症状患者中可以检测到冠状动脉粥样硬化斑块，并且其与冠心病患者的低密度脂蛋白胆固醇（LDL）水平有关。但是，研究人员尚未确定低危人群中各种斑块特征与其他脂质参数（如高密度脂蛋白胆固醇（HDL-C）和甘油三酯（TG）水平）之间的关系。
本研究共纳入 1064 名非糖尿病患者（年龄 57.86±9.73 岁；男性 752 名），他们接受了冠状动脉计算机断层扫描血管造影（CCTA），并分析了动脉粥样硬化斑块的严重程度和模式。
研究人群中有 25%的患者使用了他汀类药物，并且斑块受累程度较大的患者（节段受累评分[SIS]）年龄较大，且具有更高的体重指数（BMI）、血压、不利的血脂谱和合并症。在调整了合并症后，仅年龄（β=0.085，p＜0.001）、男性（β=1.384，p＜0.001）、BMI（β=0.055，p=0.019）和糖化血红蛋白（HbA1C）水平（β=0.894，p＜0.001）是预测非糖尿病患者更大程度的冠状动脉斑块受累的独立因素。在分析显著不同（＞50%）狭窄斑块模式时，年龄（OR：1.082，95%CI：10.47-1.118）和既往吸烟史（OR：2.061，95%CI：1.013-4.193）与钙化斑块独立相关。对于部分钙化（混合类型）斑块，仅年龄（OR：1.085，95%CI：1.052-1.119）、男性（OR：7.082，95%CI：2.638-19.018）、HbA1C 水平（OR：2.074，95%CI：1.036-4.151）和当前吸烟状态（OR：1.848，95%CI：1.089-3.138）与混合斑块中显著狭窄的存在独立相关。
即使 LDL-C 水平得到严格控制，HbA1c 水平较高也与非糖尿病患者冠状动脉粥样硬化的发生和严重程度独立相关。
