Correlation Between Non-High-Density Lipoprotein Cholesterol And Progression Of Non-Culprit Coronary Lesions In Patients After PCI

Background:Dyslipidemia is affecting people’s health in China is an important danger signal, and is closely related to the occurrence and development of coronary heart disease, atherosclerosis. A number of studies have confirmed that the low density lipoprotein cholesterol (LDL-C) plays an important role in the development of coronary heart disease, reduce the level of LDL-C can significantly reduce the occurrence and development of coronary heart disease events and coronary atherosclerosis. However, in clinical, patients with atherosclerotic disease by lowering levels of LDL-C after treatment has reached, some even< 1.8mmoL/L, but is still to develop atherosclerosis, which indicates that exist LDL-C residual risk. The scholars usually use apolipoprotein B, non-high-density lipoprotein cholesterol (Non-HDL-C) to estimate the residual risk.Objectives:The purpose of this study was to investigated the usefulness of non-high-density lipoprotein cholesterol(Non-HDL-C) for predicting progression of non-culprit coronary lesions in patients with standard of low-density lipoprotein cholesterol(LDL-C).Methods:(1) From August 1,2008 to May 7,2013, we enrolled 1180 patients who underwent successful percutaneous coronary intervention (PCI) with drug-eluting stents implantation, and were assessed by 6-24 months follow-up CAG in a single center.(2) The non-culprit coronary lesion (NCCL) progression was assessed by using three-dimensional quantitative coronary angiography (3D QCA). Patientswho achieved an on-treatment LDL-C level of<1.80mmol/L(70 mg/dl) (n=295) were stratified as NCCL progressors and non-progressors.(3) According to the level of Non-HDL-C, patients were stratified as low Non-HDL-C [HDL-C≤2.6 mmol/L(100 mg/dl)] group and non-low Non-HDL-C [HDL-C≤2.6 mmol/L(100 mg/dl)] group.Results:(1) The median age of patients was 57.8 years old. The mean angiographic follow-up period was 11.3 months,38(12.9%) patients had NCCL progression.(2) ANOVA analysis showed the baseline and follow-up Non-HDL-C in NCCL progressors were significantly greater than that in non-progressors.(3) Cox regression analysis showed that Non-HDL-C was the independent determinant of NCCL progression. Compared to the low Non-HDL-C group, the crude hazard ratio(HR) of NCCL progression for the non-low Non-HDL-C group was 2.49(95% CI,1.20 to 5.13; P=0.014), and the association remained significantly after adjustment for age, sex, BMI, SBP, DBP, serum lipids, fasting blood glucose, smoking, drinking, hypertension, diabetes mellitus and lesion characteristics of NCCL (adjusted HR 3.24,95% CI,1.25 to 8.40;P=0.015).Conclusion:(1) Non-HDL-C as a residual risk factor is associated with the NCCL progression in patients who achieve standard LDL-C levels.(2) This finding highlights the rationale for the development of Non-HDL-C targeted therapies as a potential new strategy for patients with coronary atherosclerotic progression.