The Role Of High-density Lipoprotein And Its Function In Rapid Progression Of Coronary Non-target Lesion

PURPOSE:This study aims to investigate the role of high-density lipoprotein cholesterol and its cholesterol efflux capacity function in rapid progression of coronary non-target lesion.BACKGROUND:Coronary non-target lesion progression is an important risk factor of cardiovascular events and adverse prognosis in coronary heart disease(CHD)patients after receiving percutaneous coronary intervention(PCI).High-density lipoprotein cholesterol is regarded as a cardiovascular protective factor.Its function,represented by cholesterol efflux capacity(CEC),has been found to pocesse an even better value in cardiovascular diseases.This study aims to investigate the association and potential prediction value of HDL-C and CEC in rapid progression of coronary non-target lesion.METHODS:To investigate the association between HDL-C level and coronary lesion progression,we first enrolled patients from a retrospective coronary lesion progression database.Baseline characteristics and analysis,lesion characteristics using quantitative coronary angiography(QCA),multivariate analysis,subgroup analysis were performed.We consecutively enrolled single-center patients underwent PCI with complete clinical,imaging and serum samples.We performed QCA analysis for coronary lesions and tested the cholesterol efflux capacity(CEC)with BODIPY-cholesterol.Baseline characteristics,interaction analysis and multivariate anaylsis were performed to determine the association and predictive value of CEC on coronary non-target lesion progression.Correlation analysis were conducted to further investigate the association of CEC and various patient conditions.RESULTS:813 patients(1197 non-target lesions)were enrolled form retrospective RIPPER study database.Among them,186 patients presented lesion progression(22.9%).The average follow-up time was 460.57 ± 106.46 days.HDL-C in progression group were siginificantly lower than non-progression group(p=0.006).Lesions with rapid progression had increased change in DS(29.29 ± 14.21%)and net luminal loss(0.85 ±0.49mm).Multivariate analysis indicated that lowered HDL-C is not an independent risk factor of coronary non-target lesion progression.From January 2017 to August 2019 in Ruijin Hospital,a total of 430 patients(586 lesions)with at least 1 non-target lesion after PCI were included in the final analysis.During a mean follow-up of 381.04 ± 59.52 days,plaque progression took place in 80 patients(18.6%).CEC was significantly lower in patients with lesion progression(35.53± 10.12%vs 41.72 ± 12.34%,P<0.0001).Coronary lesion progression was more severe in patients at the lower CEC quartile(net luminal loss of 0.22 ± 0.42mm and change in diameter stenosis of 7.12 ± 13.73%in the lowest quartile).The area under ROC curve of CEC for the prediction of coronary non-target lesion progression was 0.644,which is significantly better than HDL-C.Multivariate analysis indicated that lowered CEC is an independent predictor of rapid non-target coronary lesion progression,with a 57.8%decreased risk per SD increase of CEC(OR:0.522[95%CI 0.373～0.714]),independent of HDL-C and ApoA-I.Correlation anylsis indicated that CEC is inversely related to HbAlc,fasting glucose and HOMA-IR.CONCLUSION:HDL-C and its Cholesterol efflux capacity(CEC)are associated with rapid non-target lesion progression after percutaneous coronary intervention(PCI).Decreased CEC is an independent predictor of rapid coronary non-target lesion progression after PCI.Impaired glucose metabolism may participate in rapid coronary non-target lesion progression through inducing CEC impairment.